The effects of perfluoroalkyl and polyfluoroalkyl substances on female fertility: A systematic review and meta-analysis

The reproductive toxicity of perfluoroalkyl and polyfluoroalkyl substances (PFAS) has been verified in both animal and in vitro experiments, however, the association between PFAS and female fertility remains contradictory in population studies. Therefore, in this systematic review and meta-analysis, we evaluated the effects of PFAS on female fertility based on population evidence.Electronic searches of the Web of Science, PubMed, The Cochrane Library, and Embase databases were conducted (from inception to March 2022) to collect observational studies related to PFAS and female fertility. Two evaluators independently screened the literature, extracted information and evaluated the risk of bias for the included studies, meta-analysis was performed using R software.A total of 5468 records were searched and 13 articles fully met the inclusion criteria. Meta-analysis showed that perfluorooctanoic acid (PFOA) exposure was negatively associated with the female fecundability odds ratio (FOR = 0.88, 95% confidence interval (Cl) [0.78; 0.98]) and positively associated with the odds ratio for infertility (OR = 1.33, 95%Cl [1.03; 1.73]). Perfluorooctane sulfonate (PFOS) exposure was negatively associated with the fecundability odds ratio (FOR = 0.94, 95% CI [0.90; 0.98]). Pooled effect values for perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), and perfluorohexane sulfonate (PFHxS) exposure did not find sufficient evidence for an association with female fertility.Based on the evidence provided by the current study, increased levels of PFAS exposure are associated with reduced fertility in women, this was characterized by a reduction in fecundability odds ratio and an increase in odds ratio for infertility. This finding could partially explain the decline in female fertility and provide insight into risk assessment when manufacturing products containing PFAS.