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However, there has been a paucity of human evidence. We included 1176 women who underwent 1306 in vitro fertilization (IVF) cycles from the Tongji Reproductive and Environmental cohort (2018\u20132021). Dichloroacetic acid (DCAA) and trichloroacetic acid (TCAA) concentrations in follicular fluid were assessed. Elevated quartiles of DCAA and TCAA concentrations in follicular fluid had significant inverse exposure-response associations with all IVF outcomes (e.g., 16.67% and 10.14% reductions in proportion of clinical pregnancy for the highest vs lowest quartiles of DCAA and TCAA concentrations, respectively; both P for trend &amp;lt;0.01). The effects were more pronounced in women undergoing non-long GnRH agonist regimens and IVF insemination technology. The serial mediation analyses identified that a sequential pathway (oocyte \u2192 mature oocyte \u2192 zygotes with two pronuclei \u2192 good-quality embryos) mediated 21.1%\u201333.9% of HAA exposure-related inferior clinical pregnancy outcomes (implantation, clinical pregnancy, and live birth). Our findings suggest that elevated levels of HAAs in follicular fluid are associated with decreased oocyte quality and subsequent inferior IVF outcomes, strengthening human evidence that exposure to drinking water DBPs has detrimental effects on early reproductive outcomes.<\/jats:p>","DOI":"10.1021\/acs.est.6c08680","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T08:01:26Z","timestamp":1790928086000},"page":"28445-28455","source":"Crossref","is-referenced-by-count":0,"title":["Haloacetic\nAcid Disinfection Byproducts in Follicular\nFluid and\n                    <i>In Vitro<\/i>\n                    Fertilization Outcomes: A Prospective\nCohort Study in China"],"prefix":"10.1021","volume":"60","author":[{"given":"Jin-Qin","family":"Zhu","sequence":"first","affiliation":[{"name":"Huazhong University of Science and Technology , , , ,","place":["Wuhan, Hubei, P. R. 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China, 430030"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han-Qin","family":"Ye","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and Technology , , , ,","place":["Wuhan, Hubei, P. R. China, 430030"]},{"name":"Huazhong University of Science and Technology , , , ,","place":["Wuhan, Hubei, P. R. China, 430030"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"TREE Study","family":"Team","sequence":"additional","affiliation":[{"name":"Huazhong University of Science and Technology , , , ,","place":["Wuhan, Hubei, P. R. China, 430030"]},{"name":"Huazhong University of Science and Technology , , , ,","place":["Wuhan, Hubei, P. R. China, 430030"]},{"name":"Huazhong University of Science and Technology , , , ,","place":["Wuhan, Hubei, P. R. 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