Association of urinary phthalate metabolites and polycystic ovary syndrome in women undergoing in vitro fertilization.

BACKGROUND/

OBJECTIVES

Phthalates are a group of ubiquitous environmental endocrine disruptors that can be detected in human body and exert adverse effects on reproductive health. We aimed to explore the correlation of phthalate exposure with polycystic ovary syndrome (PCOS).

METHODS

We included 420 females who underwent assisted reproductive technology (ART) treatments between 2015 and 2018 in Jiangsu, China, comprising 94 PCOS cases and 326 controls. Seventeen phthalate metabolites and three metabolites of phthalate substitutes were measured in the urine before the ART treatment. Multiple logistic and linear regression models were performed to assess the relationships of phthalate exposure with PCOS and sex hormone levels, including luteinizing hormone (LH), estradiol (E2), follicle-stimulating hormone (FSH), and mediation analysis was conducted to assess the mediating effect of sex hormones. Potential covariates in the regression models include age, area of residence, household income, education, body mass index (BMI), tobacco use and alcohol intake.

RESULTS

We found that the concentration of di (2-ethylhexyl) phthalate (ΣDEHP) (aOR = 1.40, 95 % CI: 1.02-1.92, P = 0.039) was associated with higher odds of PCOS. Additionally, increased levels of ΣDEHP (β = 0.08, 95 % CI: 0.01-0.15, P = 0.021) and its metabolites were correlated with elevated LH concentrations. In the mediation analysis, elevated LH mediated 34.56 % of the association between ΣDEHP and PCOS, respectively.

CONCLUSION

Exposure to environmental levels of DEHP was associated with increased odds of PCOS, partially mediated by elevated LH levels.