Per- and polyfluoroalkyl substances (PFAS) exposure in women seeking in vitro fertilization-embryo transfer treatment (IVF-ET) in China: Blood-follicular transfer and associations with IVF-ET outcomes

Environmentally relevant concentrations of individual per- and polyfluoroalkyl substances (PFAS) and a PFAS mixture impact proliferation, migration, and gene transcription in a human myometrial cell line

Per- and polyfluoroalkyl substances (PFAS) are persistent environmental contaminants linked to adverse health effects. Epidemiological studies have linked PFAS with an increased risk of uterine diseases including fibroids however, the mechanisms involved remain to be elucidated. This study examined the impact of individual PFAS, such as legacy compounds [perfluorooctanoic acid (PFOA), perfluorooctanesulfonic acid (PFOS)] and alternative short-chain compounds [GENX/HFPO-DA and perfluorobutanesulfonic acid (PFBS)], along with a PFAS mixture, on the function and transcriptome of immortalized human myometrial cells (UT-TERT). Exposure to these PFAS resulted in increased cell viability and proliferation. Flow cytometry showed that PFOS and the PFAS mixture altered cell cycle progression, while migration assays indicated significant enhancement of cell migration following PFOS and mixture exposure. Moreover, PFOA, PFBS, and the PFAS mixture impaired gap junction intercellular communication (GJIC), suggesting possible disruptions in cellular communication in the uterine environment. Transcriptomic analysis identified extensive changes in gene expression after exposure to environmentally relevant PFAS levels, revealing common molecular pathways involved in cell signaling, lipid metabolism, and cell survival. These findings provide crucial insights into how PFAS may contribute to reproductive health risks, warranting further investigation into the long-term effects of PFAS on uterine function and overall reproductive health.

Female-specific associations of serum perfluoroalkyl and polyfluoroalkyl substances with sex hormonal/insulin dysregulation: An integrated population-based study

BACKGROUND

Ubiquitous perfluoroalkyl/polyfluoroalkyl substances (PFASs) exhibit sex-differential blood accumulation. However, sex- and age-specific links between PFASs and insulin-hormone dysregulation remain unknown.

METHODS

This population-based study utilized survey-weighted data from the National Health and Nutrition Examination Survey 2013-2016. Correlations between PFASs and sex hormone- or insulin-related indicators were assessed using a survey-weighted generalized linear model (SWGLM) for individual analyses and weighted quantile sum (WQS) regression for mixture analyses, stratified by sex and age. The mixture-related findings were validated with Bayesian kernel machine regression (BKMR) and further examined through stratification by menopausal status. Moreover, we investigated whether homeostatic model assessment of insulin resistance (HOMA-IR) mediated the relationships between sex hormones and monomethyl branched isomers of perfluorooctane sulfonate (Sm-PFOS) sex-specifically.

RESULTS

The following results persisted only in females. In SWGLM, linear perfluorooctanoate (n-PFOA) and homeostatic model assessment of β cell function (HOMA-β) were positively correlated in females, with this correlation strengthening in those aged ≥ 60. In WQS, PFAS mixture was positively associated with total testosterone/estradiol (TT/E2) and negatively associated with estradiol (E2) in females, but not in postmenopausal participants; the BKMR demonstrated trends consistent with prior findings. These associations intensified in females aged 20-59, with n-PFOA and perfluorohexane sulfonic acid (PFHxS) being main pollutants in the 20-39 and 40-59 age groups, respectively in WQS. The relationships between Sm-PFOS and both free androgen index and sex hormone-binding globulin (SHBG) were mediated by HOMA-IR.

CONCLUSIONS

This cross-sectional study reveals female-specific associations between PFASs and insulin-hormone imbalance, suggesting multifaceted influences of PFASs on female endocrinology.

In vivo gamete toxicology in the context of in vitro fertilization: a narrative review

IVF as a clinical method to surmount infertility has existed since the 1970s, and yet fertilization, embryo development, pregnancy, and live birth rates remain unacceptably low. Although a multitude of factors may contribute to stagnated success despite substantial advances in basic and applied IVF sciences, gamete quality is inarguably integral to IVF success rates. In this review, the authors will explore the role of environmental toxicology in impairing in vivo fertility and gamete quality prior to starting IVF that will influence downstream IVF success. In vivo contaminants of interest that may affect gamete potential in the context of IVF include heavy metals, per- and polyfluoroalkyl substances (PFAS), persistent organic pollutants (POPs), and airborne contaminants. By evaluating the current literature on reproductive toxicology and how toxic exposures may influence IVF, this review aims to provide a comprehensive reference of potential toxicological exposures for clinicians, to use in vitro and animal data to supplement correlative human studies with potential causative mechanisms, and to strengthen the case for patient assessment of toxicological risk.

Insight into perfluorooctanoic acid-induced impairment of mouse embryo implantation via single-cell RNA-seq

Perfluorooctanoic acid (PFOA) is an environmentally persistent chemical that poses significant risks to human health. Studies have shown that PFOA affects female reproduction, but the specific impact on endometrial receptivity and the underlying mechanisms remain poorly understood. In this study, we investigated the effects of low-dose PFOA exposure through drinking water on endometrial receptivity in a murine model. Our results demonstrate that PFOA exposure significantly impaired endometrial receptivity, which led to a marked decrease in embryo implantation rates. Utilizing single-cell RNA sequencing technology, we conducted a comprehensive analysis that revealed specific mechanisms by which PFOA disrupts the function and development of endometrial epithelial cells. Notably, we identified dysregulation of the ANGPTL (angiopoietin-like) signaling pathway, which is critical for communication between endometrial stromal and epithelial cells, ultimately contributing to embryo implantation failure. These findings provide novel insights into the reproductive toxicity of PFOA and highlight potential targets for therapeutic interventions aimed at addressing infertility associated with environmental contaminants.

Distribution of perfluorooctanoic acid in exposed female postpubertal pigs in thermal neutral or heat-stressed conditions

Perfluorooctanoic acid (PFOA), a legacy perfluoroalkyl substance with immuno- and repro-toxicant effects, has poorly characterized bioaccumulation and distribution patterns in postpubertal female pigs. The potential for heat stress (HS) to influence PFOA partitioning, potentially through intestinal hyperpermeability and alterations in systemic blood flow, also warrants investigation. This study investigated PFOA uptake, accumulation, and distribution in thermal neutral (TN) and heat-stressed gilts. Pigs (n = 48) were estrus synchronized and experienced TN (20 °C) or HS (26.6 to 32.2 °C) conditions during which they consumed 70 ng/kg bodyweight PFOA via cookie dough as vehicle control daily. Plasma was collected on d 1, 15, and 20. Liver, ovary, and follicular fluid were collected at euthanasia (d 20). Post-exposure, PFOA was detected in serum, liver, ovary, and follicular fluid. HS increased (P < 0.05) plasma PFOA compared with TN pigs on d 15, but on d 20, plasma PFOA levels in TN and HS pigs were similar. Liver PFOA concentrations were similar between TN and HS pigs. Ovarian PFOA levels tended (P = 0.06) to be higher in TN relative to HS pigs, with an opposing pattern in follicular fluid, in which PFOA concentrations were greater (P < 0.05) in HS pigs. These findings suggest that PFOA apportions to plasma, liver, ovary, and follicular fluid of exposed pigs and that HS alters PFOA distribution, which could negatively impact reproductive health. This study underscores the need to consider the interaction of HS and toxicant exposure in environmental health risk assessments.

Per- and polyfluoroalkyl substances as persistent pollutants with metabolic and endocrine-disrupting impacts

The widespread use of per- and polyfluoroalkyl substances (PFASs), and their resistance to degradation, renders human exposure to them inevitable. PFAS exposure disturbs endocrine function, potentially affecting cognitive development in newborns through thyroid dysfunction during pregnancy. Recent studies reveal varying male and female reproductive toxicity across PFAS classes, with alternative analogs affecting sperm parameters and legacy PFASs correlating with conditions like endometriosis. Metabolically, PFASs exposure is linked to metabolic disorders, including obesity, type 2 diabetes mellitus (T2DM), dyslipidemia, and liver toxicity, particularly in early childhood. This review focuses on the endocrine-disrupting impact of PFASs, particularly on fertility, thyroid, and metabolic functions. We highlight the complexity of the PFAS issue, given the large number of molecules and their extremely diverse mixed effects.

Per- and Polyfluoroalkyl Substances and Twin Growth Discordance: New Insights from a Twin Birth Cohort Study

Prenatal exposure to per- and polyfluoroalkyl substances (PFASs) has been linked to adverse fetal growth and development. However, most evidence was generated based on the singleton pregnancy studies, whereas potential impact on twin fetuses remains largely unknown. This study aimed to explore the associations of prenatal PFAS exposure with the growth and developmental differences within twin pairs by investigating 162 twin newborns and their mothers and determining 19 PFASs in maternal serum during the first, second, and third trimesters and cord serum of twins. The results revealed that exposure to selected PFASs was significantly and positively associated with the within-pair differences in the birth weight or height. For example, maternal perfluorooctanoic acid (PFOA) exposure by a 1-unit increase was significantly associated with an increase of within-pair birth weight differences (% change = 40.57%, 95% CI: 28.58-53.68%). The negative impact of PFAS exposure on birth weight or height was more pronounced in the smaller fetuses as compared with the larger fetuses within each twin pair. The impact of PFAS exposure on within-pair growth and developmental differences also differed between those of the monozygotic (MZ) and dizygotic (DZ) twins. For example, the within-pair birth weight differences in the DZ twins (% change = 57.24%, 95% CI: 38.41-78.62%) attributable to intrauterine PFOA exposure exhibited a greater effect of percentage change than those in the MZ twins (% change = 21.27%, 95% CI: 5.13-39.89%). PFAS mixtures were found to be positively associated with birth weight and height differences within newborn twins with PFOA, perfluorodecanoic acid, perfluorooctanesulfonic acid, and perfluorononanoic acid as the major contributors to the outcomes. Our study provides epidemiological evidence for the first time on the potential influence of PFAS exposure on the within-pair growth and developmental differences.

Distribution of Environmental Phenols into Follicular Fluid and Urine of Women Attending Infertility Clinic

Infertility and environmental pollution are two globally prevalent and related issues. To explore women's reproductive health, the composition of follicular fluid (FF) has been studied and it was found that changes to its composition, including the presence of exogenous chemicals, can adversely affect the fertilization process. Two groups of women (idiopathic infertility and controls) who were patients at a fertility clinic were recruited for this study. Samples of urine and FF were gathered from each participant to determine the concentration of 14 common phenols (four parabens, six bisphenols, two benzophenones, and two naphthols). Associations between phenol concentrations (free and total) in both matrices were described using Spearman's correlation coefficient and were compared between two groups by the Mann-Whitney U test. Eight phenols were quantified in more than 50% of the urine samples, while only three parabens were quantified in hydrolyzed FF samples, and only methylparaben was quantified in non-hydrolyzed FF samples. Conjugates were the predominant form in FF samples. However, a significant correlation of 0.533 (p < 0.0001) was observed between free and total methylparaben concentrations in FF. Differences in concentrations between cases and controls in both matrices were not statistically significant, except for benzophenone-3 in urine, with a higher median observed in the control group (p = 0.04). The total paraben concentrations in urine and FF samples were rather weakly correlated (r = 0.232-0.473), implying that urine concentrations may not be appropriate for predicting their concentration in FF.

Exposure to environmentally relevant levels of GenX affects placental and offspring development in mice

Hexafluoropropylene Oxide Dimer Acid (GenX or HFPO-DA), a fluorochemical used in industrial applications such as non-stick coatings and water-repellent textiles, has emerged as a replacement for perfluorooctanoic acid (PFOA). Its widespread use has led to detection in air, soil, and drinking water, raising concerns about potential health impacts. This study investigates the effects of exposure to environmentally relevant levels of GenX on placental and offspring development in mice. Female mice were exposed to GenX for short-term (11 days) or subchronic (100 days) durations. Both short-term and subchronic exposure resulted in alterations in body weight gain, placental weight, and placental efficiency. Dams exposed subchronically also exhibit altered fetal weight and impaired placental structure. In the labyrinth layer of placenta, subchronic exposure to GenX caused disordered vasculature, characterized by enlarged vessel lumens, discontinuous signals of maternal (MCT1) and fetal (MCT4) vascular networks, and impaired mitochondria in fetal sinus endothelial cells. The placental mRNA profile revealed imbalanced expression of factors essential for proper angiogenesis, with increased levels of Vegfa and Angpt1, and decreased levels of Tie2. Additionally, male pups of the subchronically exposed dams exhibited higher birth weight, increased weight gain and reduced anogenital distance (AGD), while premature puberty onset was observed in female pups. This study provides the first evidence that subchronic exposure to environmentally relevant levels of GenX affects placental angiogenesis, potentially contributing to altered development in offspring. These findings offer new insights into the health impacts of GenX on reproductive development and raise concerns about its safety as a PFOA alternative.

Exposure to perfluorodecanoic acid impairs follicular development via inducing granulosa cell necroptosis

Per- and polyfluoroalkyl substances (PFAS) have attracted significant attention due to their environmental toxicity. However, the detrimental impact of PFAS on the development of the female reproductive system remains controversial. In this study, we investigated the effects of three specific PFAS compounds perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorodecanoic acid (PFDA) on ovarian development. Among these compounds, PFDA demonstrated the most pronounced cytotoxic effect on ovarian granulosa cells. The results showed that a 200 μM concentration of PFDA induced cell apoptosis via the intrinsic pathway by elevating reactive oxygen species (ROS) levels and activating Caspase-9 and Caspase-3. Furthermore, 200 μM PFDA triggered necroptosis, a form of regulated cell death (RCD), through the receptor-interacting serine/threonine kinase 1 (RIPK1), receptor interacting protein kinase 3 (RIPK3), and mixed-lineage kinase domain-like protein (MLKL) axis, mediated by inhibition of the canonical apoptosis proteolytic enzyme Caspase-8. In vivo experiments confirmed that mice exposed to PFDA displayed a significantly reduced ovarian index compared to the control group, accompanied by evident follicular atresia. Ovarian tissues from the PFDA-exposed group showed upregulated necroptosis markers, which were effectively mitigated by inhibiting the phosphorylation of RIPK1 at Ser166. Importantly, this study provides the first evidence that PFDA disrupts ovarian development through a novel mechanism involving the RIPK1-mediated necroptosis pathway, alongside the detection of the intrinsic apoptosis pathway. This greatly expands our insight into the effects of PFDA on cell death. This finding highlights the potential public health hazards associated with PFDA exposure and emphasizes the need for further research to fully understand its broader implications.

Per- and Polyfluoroalkyl Substances (PFASs) and Their Potential Effects on Female Reproductive Diseases

Per- and polyfluoroalkyl substances (PFASs) are a class of anthropogenic organic compounds widely present in the natural and human living environments. These emerging persistent pollutants can enter the human body through multiple channels, posing risks to human health. In particular, exposure to PFASs in women may cause a series of reproductive health hazards and infertility. Based on a review of the existing literature, this study preliminarily summarizes the effects of PFAS exposure on the occurrence and development of female reproductive endocrine diseases, such as polycystic ovary syndrome (PCOS), endometriosis, primary ovarian insufficiency (POI), and diminished ovarian reserve (DOR). Furthermore, we outline the relevant mechanisms through which PFASs interfere with the physiological function of the female ovary and finally highlight the role played by nutrients in reducing the reproductive health hazards caused by PFASs. It is worth noting that the physiological mechanisms of PFASs in the above diseases are still unclear. Therefore, it is necessary to further study the molecular mechanisms of PFASs in female reproductive diseases and the role of nutrients in this process.

An environmentally relevant mixture of per- and polyfluoroalkyl substances (PFAS) impacts proliferation, steroid hormone synthesis, and gene transcription in primary human granulosa cells

Per- and polyfluoroalkyl substances (PFAS) are a group of synthetic chemicals that are resistant to biodegradation and are environmentally persistent. PFAS are found in many consumer products and are a major source of water and soil contamination. This study investigated the effects of an environmentally relevant PFAS mixture (perfluorooctanoic acid [PFOA], perfluorooctanesulfonic acid [PFOS], perfluorohexanesulfonic acid [PFHxS]) on the transcriptome and function of human granulosa cells (hGCs). Primary hGCs were harvested from follicular aspirates of healthy, reproductive-age women who were undergoing oocyte retrieval for in vitro fertilization. Liquid Chromatography with tandem mass spectrometry (LC/MS-MS) was performed to identify PFAS compounds in pure follicular fluid. Cells were cultured with vehicle control or a PFAS mixture (2 nM PFHxS, 7 nM PFOA, 10 nM PFOS) for 96 h. Analyses of cell proliferation/apoptosis, steroidogenesis, and gene expression were measured via 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assays/immunofluorescence, ELISA/western blotting, and RNA sequencing/bioinformatics, respectively. PFOA, PFOS, and PFHxS were detected in 100% of follicle fluid samples. Increased cell proliferation was observed in hGCs treated with the PFAS mixture with no impacts on cellular apoptosis. The PFAS mixture also altered steroid hormone synthesis, increasing both follicle-stimulating hormone-stimulated and basal progesterone secretion and concomitant upregulation of STAR protein. RNA sequencing revealed inherent differences in transcriptomic profiles in hGCs after PFAS exposure. This study demonstrates functional and transcriptomic changes in hGCs after exposure to a PFAS mixture, improving our knowledge about the impacts of PFAS exposures and female reproductive health. These findings suggest that PFAS compounds can disrupt normal granulosa cell function with possible long-term consequences on overall reproductive health.

Associations of legacy perfluoroalkyl and polyfluoroalkyl substances, alternatives, and isomers with gestational diabetes mellitus and glucose homeostasis among women conceiving through assisted reproduction in Shanghai, China

Prior research has reported that perfluoroalkyl and polyfluoroalkyl substances (PFAS) may be linked to impaired glucose homeostasis in pregnant women. However, few studies have investigated PFAS alternatives and isomers, and even less is known about the association among women conceiving through assisted reproductive technology (ART). The prospective cohort study aimed to explore associations of legacy PFAS, alternatives and isomers with gestational diabetes mellitus (GDM) and glucose homeostasis during pregnancy among 336 women conceiving through ART. Nineteen PFAS, including nine linear legacy PFAS, four short-chain alternatives, four branched isomers, and two emerging PFAS alternatives, were determined in first-trimester maternal serum. Fasting plasma glucose (FPG), 1-h and 2-h glucose concentrations following the oral glucose tolerance test (OGTT), and glycated hemoglobin (HbA1c) were measured during the second trimester. After adjusting for confounding variables, nearly half of individual PFAS (10/19) and PFAS mixtures were correlated with increased GDM risk or elevated 2-h glucose levels. Among PFAS congeners, emerging PFAS alternatives, chlorinated perfluoroalkyl ether sulfonic acids (Cl-PFESAs), showed a notable association with impaired glucose homeostasis. For example, 6:2 Cl-PFESA exhibited a correlation with GDM (OR = 1.31, 95% CI = 1.02, 1.68) and 2-h glucose concentrations (β = 0.22, 95% CI = 0.08, 0.36), and contributed most to the overall association with 2-h glucose concentrations. Compared to those diagnosed with male factor infertility, the associations were more pronounced in infertile women with reproductive endocrine diseases. We provide evidence that exposure to PFAS, especially emerging PFAS alternatives, may impair glucose homeostasis and increase the risk of GDM among women conceiving through ART.

Phthalate metabolites in urine and follicular fluid in relation to menstrual cycle characteristics in women seeking fertility assistance

BACKGROUND

Phthalates have been shown to disrupt the estrous cycle in animal studies. However, epidemiological research investigating their associations with menstrual cycle characteristics is limited.

OBJECTIVE

To explore the relationships between phthalate exposure and menstrual cycle characteristics among women seeking fertility assistance.

METHODS

We determined the levels of eight phthalate metabolites in both follicular fluid (FF) and urine specimens collected from 441 women in the Tongji Reproductive and Environmental (TREE) cohort, using high-performance liquid chromatography and tandem mass spectrometry. Information about menstrual cycle parameters was obtained through a questionnaire. The impacts of individual and joint exposure to phthalates on menstrual cycle characteristics were assessed using multivariable linear regression, Poisson regression, and quantile g-computation approaches.

RESULTS

After adjusting for relevant covariates, we found that per log10-unit increase in mono(2-ethylhexyl) phthalate (MEHP) level in urine specimens was associated with a decrease of 0.20 days (95 % CI: -0.37, -0.03) in bleeding duration. We also observed that mono(2-ethyl-5-carboxypentyl) phthalate (MECPP) and the sum of di(2-ethylhexyl) phthalate (DEHP) metabolites (∑DEHP) concentrations in FF samples were inversely related to cycle length [β = -1.92 (95 % CI: -3.10, -0.75) and -1.87 (95 % CI: -3.56, -0.19), respectively]. However, we generally observed null associations between phthalate metabolites and irregular cycle, dysmenorrhea, hypomenorrhea, or cycle length variation. Furthermore, we also found that phthalate metabolite mixtures in FF and urine were generally unrelated to menstrual cycle characteristics.

CONCLUSION

Our findings suggest that some DEHP metabolites in FF and urine are inversely associated with menstrual cycle length and menstrual bleeding duration in women attending a fertility center.

Associations between Phthalate Metabolite Concentrations in Follicular Fluid and Reproductive Outcomes among Women Undergoing in Vitro Fertilization/Intracytoplasmic Sperm Injection Treatment

BACKGROUND

Phthalates have been reported to impair fertility in various studies. However, evidence exploring the associations between phthalate metabolites in follicular fluid (FF) and reproductive outcomes is lacking.

OBJECTIVES

To investigate the associations between phthalate metabolite concentrations in FF and in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) outcomes among women recruited from a fertility clinic.

METHODS

We included 641 women undergoing IVF/ICSI treatment from December 2018 to January 2020. The levels of eight phthalate metabolites, including monoethyl phthalate (MEP), mono-isobutyl phthalate (MiBP), mono-n -butyl phthalate (MBP), monobenzyl phthalate (MBzP), mono(2-ethylhexyl) phthalate (MEHP), mono(2-ethyl-5-hydroxyhexyl) phthalate (MEHHP), mono(2-ethyl-5-oxohexyl) phthalate (MEOHP), and mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), were quantified in FF collected on the oocyte retrieval day. Associations between quartiles of individual phthalate metabolite concentrations and nine IVF/ICSI outcomes, including oocyte yield, mature oocyte number, two distinct pronuclei (2PN) zygote number, fertilization rate, blastocyst formation rate, implantation, clinical pregnancy, miscarriage, and live birth, were estimated with generalized linear models. The effects of phthalate mixtures on IVF/ICSI outcomes were assessed using Bayesian kernel machine regression (BKMR) models.

RESULTS

After adjusting for relevant confounders, elevated quartiles of MBzP, MEHHP, and MEHP in FF were inversely associated with the numbers of retrieved oocytes, mature oocytes, and 2PN zygotes (all p for trends < 0.10 ). In comparison with the lowest quartile, the highest quartile of molar sum of di(2-ethylhexyl) phthalate metabolites (Σ DEHP ) was associated with a reduction of 9.1% [95% confidence interval (CI): - 17.1 % , - 0.37 % ] and 10.3% (95% CI: - 18.8 % , - 0.94 % ) in yielded oocyte and mature oocyte numbers, respectively. Furthermore, the BKMR models revealed inverse associations between phthalate mixtures and the numbers of retrieved oocytes and mature oocytes. We generally found null results for implantation, clinical pregnancy, miscarriage, and live birth.

DISCUSSION

Certain phthalate metabolites in FF are inversely associated with the numbers of retrieved oocytes, mature oocytes, and 2PN zygotes among women undergoing IVF/ICSI treatment. https://doi.org/10.1289/EHP11998.

Exposure to per- and polyfluoroalkyl substances in women with twin pregnancies: Patterns and variability, transplacental transfer, and predictors

The extensive exposure to per- and polyfluoroalkyl substances (PFASs) has raised public health concerns. The issue of PFAS exposures in women with twin pregnancies remains unresolved. To determine exposure profiles, the transplacental transfer efficiencies (TTEs) of PFASs and predictors were estimated. We found that serum PFASs were widely detected, with detection rates of over 50% for 12 PFASs in maternal serum throughout pregnancy. The majority of PFAS levels exhibited fair to good reproducibility (ICCs > 0.40). Moderate to low correlations were observed for most PFASs between twin cord serum and maternal serum at three trimesters (rs = 0.13-0.77, p values < 0.01). We first presented a U-shaped trend for TTEs with increasing chain length for perfluoroalkyl carboxylic acids (PFCAs) and perfluoroalkyl sulfonic acids (PFSAs) in twins, even in twin sex subgroups. Further, we found that PC4 and PC5 (indicators of exposure to PFHxS and 6:2 Cl-PFESA) were positively associated with age (β = 0.85, 1.30, and 1.36, respectively). Our findings suggested that there is moderate variability among certain PFASs and that these PFASs have the ability to cross the placental barrier. Exposure patterns were found to be associated with maternal age.

Per- and polyfluoroalkyl substances (PFAS) in breast milk and infant formula: A global issue

BACKGROUND

Per- and polyfluoroalkyl substances (PFAS) are transferred from mother to infants through breastfeeding, a time when children may be particularly vulnerable to PFAS-mediated adverse health effects. Infants can also be exposed to PFAS from infant formula consumption. Our recent literature-based scoping of breast milk levels reported that four PFAS often exceeded the United States Agency for Toxic Substances and Disease Registry (ATSDR) children's drinking water screening levels in both the general population and highly impacted communities in the U.S. and Canada. This work presents a comparison of global breast milk and infant formula PFAS measurements with the only reported health-based drinking water screening values specific to children.

METHODS

We focused on four PFAS for which ATSDR has developed children's drinking water screening values: PFOA (perfluorooctanoic acid), PFOS (perfluorooctanesulfonic acid), PFHxS (perfluorohexanesulfonic acid), and PFNA (perfluorononanoic acid). Published literature on PFAS levels in breast milk and infant formula were identified via PubMed searches. Data were compared to children's drinking water screening values.

DISCUSSION

Breast milk concentrations of PFOA and PFOS often exceed children's drinking water screening values, regardless of geographic location. The limited information on infant formula suggests its use does not necessarily result in lower PFAS exposures, especially for formulas reconstituted with drinking water containing PFAS. Unfortunately, individuals generally cannot know whether their infant's exposures exceed children's drinking water screening values. Thus, it is essential that pregnant and lactating women and others, especially those having lived in PFAS-contaminated communities, have data required to make informed decisions on infant nutrition. An international monitoring effort and access to affordable testing are needed for breast milk, drinking water and infant formula to fully understand infant PFAS exposures. Currently, our understanding of demonstrable methods for reducing exposures to emerging PFAS is limited, making this research and the communications surrounding it even more important.

Effect of PFOA exposure on diminished ovarian reserve and its metabolism

Owing to its difficulty in degrading and ease of accumulation in the body, perfluorooctanoic acid (PFOA) has a detrimental effect on reproduction. This study aimed to examine the effect of PFOA concentration in follicular fluid during ovulation stimulation on embryo quality and the impact of PFOA exposure on the metabolic components of follicular fluid. This was a single-center prospective study that included 25 patients with diminished ovarian reserve (DOR), 25 with normal ovarian reserve (NOR), and 25 with polycystic ovary syndrome (PCOS). Follicular fluid samples were analyzed using ultra-high performance liquid chromatography-tandem mass spectrometry. We demonstrated that the PFOA levels of follicular fluid in the DOR group were higher than those in the NOR group and PCOS group (P < 0.05). PFOA concentration in the PCOS group was negatively correlated with high-quality embryos (P < 0.05). To gain more insight into the impact of PFOA on the metabolic composition of follicular fluid, we classified the DOR group based on the PFOA concentration, for which metabolomic analysis was performed. In the high-concentration PFOA group, there was an increase and a decrease in three and nine metabolites, respectively, compared to that in the low-concentration group. These results suggest that PFOA may alter the metabolic composition of follicular fluid, thus, affecting ovarian reserve function.

Perfluoroalkyl Acids in Follicular Fluid and Embryo Quality during IVF: A Prospective IVF Cohort in China

BACKGROUND

Perfluoroalkyl acids (PFAA) have been measured in ovarian follicular fluid from women using in vitro fertilization (IVF), although associations between follicular fluid PFAA and IVF outcomes have been inconsistent.

OBJECTIVES

We investigated the association between follicular fluid PFAA and embryo quality in women undergoing IVF.

METHODS

We prospectively enrolled 729 women undergoing IVF treatment in Guangxi province, China, from July 2018 to December 2018. We measured 32 PFAA, including branched isomers, in follicular fluid using ultra-performance liquid chromatography coupled to tandem mass spectrometry. We applied restricted cubic splines, linear regression, and log-binominal regression models to investigate associations between follicular fluid PFAA and embryo quality, adjusting for confounding variables and investigated oocyte maturity as an intervening variable using causal mediation analysis. We further estimated the overall effect of the PFAA mixture on outcomes using Bayesian kernel machine regression (BKMR).

RESULTS

We detected 8 of 32 measured PFAA in >85% of follicular fluid samples. Higher PFAA concentrations were associated with fewer high-quality embryos from IVF. The high-quality embryo rates at the 50th percentile of linear perfluoro-1-octanesulfonate acid (n-PFOS), all branched PFOS isomers (Br-PFOS) and linear perfluoro-n-octanoic acid (n-PFOA) were -6.34% [95% confidence interval (CI): -9.45, -3.32%], -16.78% (95% CI: -21.98, -11.58%) and -8.66% (95% CI: -11.88, -5.43%) lower, respectively, than the high quality embryo rates at the reference 10th percentile of PFAA. Oocyte maturity mediated 11.76% (95% CI: 3.18, 31.80%) and 14.28% (95% CI: 2.95, 31.27%) of the n-PFOS and n-PFOA associations, respectively. The results of the BKMR models showed a negative association between the PFAA mixture and the probability of high-quality embryos, with branched PFOS isomers having posterior inclusion probabilities of 1 and accounting for the majority of the association.

DISCUSSION

Exposure to higher PFAA concentrations in follicular fluid was associated with poorer embryo quality during IVF. Branched PFOS isomers may have a stronger effect than linear PFOS isomers. More studies are needed to confirm these findings and to directly estimate the effects on pregnancy and live-birth outcomes. https://doi.org/10.1289/EHP10857.