Associations between per- and polyfluoroalkyl substances and reproductive outcomes among women undergoing in vitro fertilization/intracytoplasmic sperm injection treatment.

Exposure to per- and poly-fluoroalkyl substances (PFAS) has been reported to impair fertility in experimental models. However, studies on female reproductive outcomes are limited to a few legacy PFAS. This study linked exposure to various PFAS with reproductive outcomes in women undergoing IVF/ICSI. A total of 275 women were recruited, and plasma concentrations of 17 PFAS were quantified. Based on analysis using the adjusted generalized linear models, an increase in the quartile of 6:2Cl-PFESA was associated with a decrease in the number of 2PN zygotes [9.33, 95 %CI: (3.63, 15.03)] and 2PN cleavage embryos [9.20, 95 %CI: (3.57, 14.83)]. Higher quartiles of 8:2Cl-PFESA were associated with lower fertilization rate [67.44, 95 %CI: (47.91, 86.97)]. Long-chain PFAS (PFUnDA, PFTrDA, PFTeDA) were negatively correlated with oocytes quantity and embryo quality. PFHxS was associated with a reduced number of high-quality blastocysts [55.72, 95 %CI: (17.72, 93.72)]. Increased PFOA levels were associated with lower number of patients who achieved biochemical and clinical pregnancy outcomes. Quantile G-computation (QGC) showed that mixed PFAS exposures were negatively correlated with the number of oocytes retrieved, mature oocytes, 2PN zygotes, 2PN cleavage embryos, high-quality embryos, high-quality blastocysts and the number of blastocysts formed. Our results indicate that exposure to a variety of PFAS was inversely associated with the number of extracted oocytes, mature oocytes, 2PN zygotes, 2PN cleavage embryos, high-quality embryos, and high-quality blastocysts among women undergoing IVF/ICSI treatment. Our study highlights the potential reproductive toxicity of PFAS and the need for further research to determine its impact on human fertility.