PMID- 36723383 OWN - NLM STAT- MEDLINE DCOM- 20230203 LR - 20230322 IS - 1552-9924 (Electronic) IS - 0091-6765 (Print) IS - 0091-6765 (Linking) VI - 131 IP - 2 DP - 2023 Feb TI - Perfluoroalkyl Acids in Follicular Fluid and Embryo Quality during IVF: A Prospective IVF Cohort in China. PG - 27002 LID - 10.1289/EHP10857 [doi] LID - 027002 AB - 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. FAU - Zeng, Xiao-Wen AU - Zeng XW AD - Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China. AD - Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Sun Yat-sen University, Guangzhou, China. FAU - Bloom, Michael S AU - Bloom MS AD - Department of Global and Community Health, George Mason University, Fairfax, Virginia, USA. FAU - Wei, Fu AU - Wei F AD - Department of Anatomy and Embryology. Leiden University Medical Center, Leiden, The Netherlands. AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Liu, Liling AU - Liu L AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Qin, Jie AU - Qin J AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Xue, Lintao AU - Xue L AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Wang, Shikai AU - Wang S AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Huang, Guolan AU - Huang G AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Teng, Min AU - Teng M AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - He, Bing AU - He B AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Mao, Xianbao AU - Mao X AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. FAU - Chu, Chu AU - Chu C AD - Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China. AD - Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Sun Yat-sen University, Guangzhou, China. FAU - Lin, Shao AU - Lin S AD - Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, 12 Albany, NY, USA. AD - Department of Epidemiology and Biostatistics, University at Albany, State University of New York, Rensselaer, 12 Albany, NY, USA. FAU - Dong, Guang-Hui AU - Dong GH AUID- ORCID: 0000-0002-2578-3369 AD - Department of Occupational and Environmental Health, School of Public Health, Sun Yat-sen University, Guangzhou, China. AD - Guangdong Provincial Engineering Technology Research Center of Environmental and Health Risk Assessment, Sun Yat-sen University, Guangzhou, China. FAU - Tan, Weihong AU - Tan W AD - Department of Reproductive Medicine and Genetics Center, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China. LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230201 PL - United States TA - Environ Health Perspect JT - Environmental health perspectives JID - 0330411 RN - 0 (Alkanesulfonic Acids) RN - 0 (Fluorocarbons) SB - IM MH - Pregnancy MH - Female MH - Humans MH - Follicular Fluid MH - *Alkanesulfonic Acids MH - Prospective Studies MH - *Fluorocarbons MH - Bayes Theorem MH - China MH - Fertilization in Vitro PMC - PMC9891133 EDAT- 2023/02/02 06:00 MHDA- 2023/02/04 06:00 PMCR- 2023/02/01 CRDT- 2023/02/01 09:44 PHST- 2023/02/01 09:44 [entrez] PHST- 2023/02/02 06:00 [pubmed] PHST- 2023/02/04 06:00 [medline] PHST- 2023/02/01 00:00 [pmc-release] AID - EHP10857 [pii] AID - 10.1289/EHP10857 [doi] PST - ppublish SO - Environ Health Perspect. 2023 Feb;131(2):27002. doi: 10.1289/EHP10857. Epub 2023 Feb 1.