The effects of perfluoroalkyl and polyfluoroalkyl substances on female fertility: A systematic review and meta-analysis.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 36334833 · doi:10.1016/j.envres.2022.114718
What was done
Authors conducted a systematic review and meta-analysis of observational studies searched across Web of Science, PubMed, The Cochrane Library, and Embase from inception through March 2022. Two independent reviewers screened records, extracted data, and evaluated risk of bias to quantify associations between specific perfluoroalkyl and polyfluoroalkyl substances (PFOA, PFOS, PFNA, PFDA, PFHxS) and female fertility endpoints (fecundability odds ratios [FOR] and infertility odds ratios [OR]) using R software.
What was found
Thirteen articles met inclusion criteria from 5,468 screened records. PFOA exposure was significantly associated with a lower fecundability odds ratio (FOR = 0.88, 95% CI [0.78, 0.98]) and higher odds of infertility (OR = 1.33, 95% CI [1.03, 1.73]). PFOS exposure was also associated with reduced fecundability (FOR = 0.94, 95% CI [0.90, 0.98]). Pooled analyses for PFNA, PFDA, and PFHxS found insufficient evidence of an association with female fertility.
Why it matters
This meta-analysis clarifies conflicting epidemiological reports by showing that exposure to common legacy PFAS compounds (PFOA and PFOS) is linked to measurable reductions in female fecundability and higher infertility rates.
Limits
Findings rely entirely on observational studies, which cannot establish causality and remain vulnerable to unmeasured confounding and reverse causation. The review includes a relatively small number of studies (n = 13), and total human participant sample size, between-study heterogeneity, and exposure measurement methods are not reported in the abstract.
Cited by
- supports PFAS forever chemicals have been linked to hormone disruption, gut microbiome disruption, and fertility issues.