Assessment of mycotoxin exposure in women undergoing assisted reproduction: A study of urinary biomarkers related to oocyte and embryo development.

Mycotoxins are widespread food contaminants, and urinary biomarkers reflect recent dietary exposure. Although mycotoxins have been implicated in reproductive toxicity, their impact on human oocyte and embryo development remains poorly characterized. This single-center, retrospective observational study investigated the association between urinary mycotoxin exposure, infertility subtypes, and embryo developmental parameters in women undergoing assisted reproductive technology (ART). A total of 124 women undergoing ART cycles between November 2024 and September 2025 were included. Infertile patients were stratified according to infertility diagnosis (endometriosis, polycystic ovary syndrome, poor ovarian response, advanced maternal age, unexplained infertility) and compared with female controls from couples with male-factor infertility. First-morning urine samples collected on the day of oocyte retrieval were analyzed for a panel of 25 mycotoxins using LC-MS/MS. Embryo development was monitored by time-lapse imaging to assess embryo quality and morpho-kinetic parameters. Urinary mycotoxins were frequently detected, with higher detection rates and levels observed in infertile women than controls, and distinct exposure profiles across infertility subtypes. Aflatoxin G1 (AFG1) was uniquely associated with impaired blastocyst quality, including reduced expansion and altered inner cell mass and trophectoderm morphology, independently of clinical predictors. Other mycotoxins were associated with alterations in early embryo cleavage kinetics prior to embryonic genome activation, while later developmental timings were unaffected. These findings suggest that dietary mycotoxin exposure may influence early human embryo development in ART, supporting the relevance of environmental biomonitoring in reproductive medicine. Further studies are required to confirm these findings and support future strategies to minimize potential reproductive risks.