Cohort studyindependent cross-checkabstract checked★ key study I-VEG-140 standard review
High-residue produce linked to lower IVF success
Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology.
Overview
Chiu YH et al.. JAMA Intern Med 2018 · PMID 29084307 · DOI 10.1001/jamainternmed.2017.5038
Women eating the most high-residue fruit and vegetables had 26% lower chance of live birth after fertility treatment.
Does the study support the specific claim? Partly · Methodological quality: moderate
Plain-language summary
Study explained simply
- What did the researchers want to find out?
Relate residue intake to ART outcomes.
- How was the study done?
Cohort.
- How many people, animals or samples were studied?
325 women.
- What was actually found?
High-residue FV linked to fewer births.
- How large was the observed effect?
-26% live birth.
- What do the results mean in everyday life?
Choosing lower-residue produce may be sensible for people trying to conceive.
- What are the study's limitations?
Small, selected.
- What does it say about Elawady's specific claim?
Partial support.
- Do the results apply to Germany and Europe?
Moderate.
- What can explicitly not be concluded from this study?
Cannot show vegetables in general are harmful.
Scientific in-depth review
1. Full reference
- Authors
- Chiu YH et al.
- Journal
- JAMA Intern Med
- Year
- 2018
- Identifier
- PMID 29084307 DOI 10.1001/jamainternmed.2017.5038
- Verification
- verified – PubMed efetch 2026-10-26; Crossref 2026-10-26
- Retracted
- no
- Corrections
- none
- Extent checked
- abstract only
- Conflicts of interest and funding
Funding (PubMed grant list): NIDDK NIH HHS; NIEHS NIH HHS
2. Research question
Is preconception intake of pesticide residues from FV associated with ART outcomes?
3. Study design and population
- Study design
- Cohort study – Prospective cohort (EARTH study) of women undergoing assisted reproduction
- Population
Women at a US fertility centre
- Country
USA
- Period
2007-2016
- Sample size
325 women, 541 ART cycles
- Inclusion and exclusion criteria
not stated in abstract
4. Methods and endpoints
- Exposure / intervention
High- and low-pesticide-residue FV intake
- Comparator
Lowest quartile
- Endpoints
Clinical pregnancy, live birth per cycle
- Statistical methods
Cluster-weighted GEE
5. Actual results
- Results
Highest vs lowest quartile of high-residue FV (>=2.3 vs <1.0 servings/day): 18% (5%-30%) lower probability of clinical pregnancy and 26% (13%-37%) lower probability of live birth; low-residue FV intake not associated.
- Absolute risks
not reported
- Authors' conclusion
Higher consumption of high-pesticide-residue FV was associated with lower probabilities of pregnancy and live birth following ART.
6. Strengths
- Prospective; validated residue classification
7. Weaknesses
- Small, selected infertility population
- Single centre
- Residue classification indirect
8. Risk of bias
- Orienting tool
- ROBINS-E
- Type of assessment
- simplified assessment (abstract only)
- Full formal assessment
- no
- Overall risk of bias
- some concerns
- Rationale
Confounding and selection.
9. Assessment of the statistical interpretation
Converted ratios 0.82 (0.70-0.95) and 0.74 (0.63-0.87) (stats/C-VEG-13_pesticide_residue.py).
10. Relevance to the specific claim
Supporting signal that dietary pesticide residues may affect a sensitive outcome.
11. Independent contrary findings
Sandoval-Insausti 2022 (no harm on mortality).
12. Transferability to Germany and Europe
US residue profiles.
13. Overall methodological judgement
Supports a possible harm in a specific sensitive group; does not show that vegetables overall are harmful.
| Multidimensional assessment | |
|---|---|
| Authenticity of the source | verified |
| Methodological quality | moderate |
| Risk of bias | some concerns |
| Precision of results | moderate |
| Directness | direct |
| Reproducibility | not replicated |
| Consistency with the overall evidence | unknown |
| Regional transferability | moderate |
| Adequacy of the interpretation (by the archive) | not applicable |
14. Open questions
Replication.