Association between phthalate exposure and reproductive health in patients undergoing assisted reproductive treatment: A systematic review and meta-analysis.

This systematic review and meta-analysis synthesizes current literature examining the relationship between phthalate exposure and reproductive health in patients undergoing assisted reproductive treatment (ART). We conducted a comprehensive search across multiple databases, including PubMed, Web of Science, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), and Wanfang databases. From 16 relevant publications identified, five studies were included in the systematic review and 11 in the meta-analysis. Our findings indicate that most of the 18 phthalate metabolites analyzed demonstrated negative associations with reproductive health outcomes in ART patients. High molecular weight phthalates, particularly mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), were most frequently linked to adverse outcomes, followed by metabolites such as mono-isobutyl phthalate (MiBP), mono-benzyl phthalate (MBzP). Both high and low molecular weight phthalates, including monoethyl phthalate (MEP) and MiBP, were correlated with negative reproductive outcomes. However, no significant associations were observed between mono-2-ethyl-5-hydroxyhexyl terephthalate (MEHHTP) or mono-3-hydroxybutyl phthalate (MHBP) and reproductive health parameters. Our analysis suggests that phthalate exposure may adversely affect fertility, hormone levels, and gamete quality, while also being associated with pregnancy complications and oxidative stress. These findings underscore the need for further large-scale studies to confirm these relationships and their clinical implications.