Study The Association Of Perfluorinated Compounds Exposure Levels In Serum And Follicular Fluid Of Infertile Women With Assisted Reproductive Pregnancy Outcomes

BackgroundPerfluorinated compounds(PFCs)are a class of perfluorohydrophobic linear carbon chain compounds linked by various hydrophilic groups.The main daily exposures are PFOA,PFOS,PFHxS and PFNA.Because of the ability of fluorocarbon bonds to resist hydrolysis,photolysis and biodegradation.It is of great value in many applications such as textiles,pesticides,fire fighting foam,food packaging,pharmaceuticals and electronics.PFCs can enter organisms through contaminated food,drinking water and air,occupational exposure,and exposure to everyday consumer products.Although the chemical structure of PFCs is different from the chemical structure of reproductive hormones,PFCs still have endocrine disrupting properties.A large number of animal studies have shown that exposure to PFCs can cause endocrine hormone synthesis and metabolic disorders,impaired oocyte maturation,and embryonic dysplasia in mammals.These phenomena are often associated with a series of adverse clinical pregnancy outcomes,including miscarriage,abnormal fetal development and increased risk of offspring diseases.Epidemiological survey data show that the exposure dose of PFCs in humans is far lower than the exposure dose in animal experiments,which makes the experimental results of animal experiments are not completely consistent with the results of epidemiological investigations.Therefore,we need to further explore its causal relationship.ART has become an important means of treatment for infertility.The ART process provides a valuable opportunity to explore the effects of environmental exposures on fertility in the ovarian microenvironment.ObjectiveTo explore the relationship between the exposure levels of four PFCs(PFOS,PFOA,PFHxS and PFNA)in serum and follicular fluid of infertile women and assisted reproductive related indicators and pregnancy outcomes.MethodsThis study selected the IVF/ICSI-ET treatment from the Center of Reproductive Medicine,the First Affiliated Hospital of Zhengzhou University from August 2017 to November 2017.There were 144 infertile female patients who provided blood and follicular fluid on the day of oocyte retrieval.UPLC-MS/MS was used to determine the content of four PFCs in serum and follicular fluid.Generalized linear model and multivariate logistic regression were used to analyze the relationship between PFCs exposure levels in serum and follicular fluids and assisted reproductive related indicators and pregnancy outcomes.ResultsThe detection rate of PFOA in serum and follicular fluid was 100%,and the median levels were 2.4 ng/mL and 2.2 ng/mL,respectively.The detection rates of PFOS in serum and follicular fluid were 88.9% and 86.8%,and the median levels were 1.5 ng/mL and 1.3 ng/mL,respectively.The detection rates of PFHxS in serum and follicular fluid were 44.4% and 42.3%,and the median levels were 1.5 ng/mL and 0.6 ng/mL,respectively.The detection rates of PFNA in serum and follicular fluid were 16.7% and 15.2%,and the median levels were 0.6 ng/mL and 0.4 ng/mL,respectively.There was a significant positive correlation between serum and follicular fluid exposure to four PFCs in infertile women(P < 0.001).Due to the low detection rate of PFHxS and PFNA in follicular fluid and serum,they have not been analyzed in this subject.According to the tertile method,the levels of PFOA and PFOS in blood and follicular fluid of infertile women were divided into three groups: low,medium and high.There were no significant differences in age,BMI,clinical indicators and fertilization patterns among the three groups of infertile women(P > 0.05).After controlling the confounding factors,serum levels of PFOA and PFOS had no significant effect on assisted reproductive related indicators and pregnancy outcomes(P-trend > 0.05).There was a negative dose-effect relationship between PFOS exposure level and fertilization rate in follicular fluid(P-trend < 0.05),but had no significant effect on other related indicators of assisted reproduction and pregnancy outcomes(P-trend > 0.05).The level of PFOA exposure in follicular fluid had no significant effect on the indicators of assisted reproductive and pregnancy outcome(P-trend > 0.05).Conclusions1.Low levels of PFCs were detected in serum and follicular fluid of infertile women,with PFOS and PFOA as the main detecters.2.There was a significant positive correlation between serum and follicular fluid exposure to four PFCs in infertile women,and serum could be used as a suitable indicator for assessing PFCs exposure in the ovarian microenvironment.3.This study did not find that serum levels of PFOA and PFOS had an effect on assisted reproductive-related indicators and pregnancy outcomes.4.There was a negative dose-effect relationship between PFOS exposure level and fertilization rate in follicular fluid,but there was no obvious dose-effect relationship with other related indicators of assisted reproduction and pregnancy outcome.5.PFOA exposure level in follicular fluid had no significant effect on assisted reproductive related indicators and pregnancy outcome.6.Therefore,whether environmental level PFCs exposure will have an impact on the indicators related to assisted reproduction and pregnancy outcome still needs to be further confirmed by expanding the sample size.