Association of bisphenol A exposure with in vitro fertilization outcomes: A meta-analysis and systematic review.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 41005444 · doi:10.1016/j.reprotox.2025.109071
What was done
This systematic review and meta-analysis searched PubMed, Web of Science, EMBASE, and the Cochrane Library through April 19, 2024, to evaluate the association between bisphenol A (BPA) exposure and in vitro fertilization (IVF) / intracytoplasmic sperm injection (ICSI) outcomes. Exposure was assessed across maternal and paternal matrices (urinary, serum, follicular fluid, and semen BPA). Effect sizes were pooled using regression coefficients (β) and 95% confidence intervals (CIs). A total of 14 studies were included in the final meta-analysis.
What was found
Maternal urinary median or geometric mean (GM) BPA levels ranged from 0.063 to 2.61 ng/mL across studies. BPA exposure across tested matrices was negatively associated with normal fertilization rates (β: -0.05; 95% CI: -0.07, -0.03) and the number of high-quality embryos (β: -0.05; 95% CI: -0.09, -0.01). In subgroup analysis, higher BPA exposure (>1.55 ng/mL median/GM) showed a stronger negative association with normal fertilization rates (β: -0.19; 95% CI: -0.27, -0.11). No significant associations were observed for clinical pregnancy rates, blastocyst formation, or implantation success rates.
Why it matters
The findings indicate that environmental BPA exposure is correlated with poorer early embryological parameters in assisted reproduction, specifically fertilization and embryo grade, though downstream clinical outcomes like pregnancy were not significantly linked.
Limits
All included studies were observational, which precludes causal claims. Exposure was measured across varied biological matrices (urine, serum, follicular fluid, semen) with differing normalization methods. Total participant sample size is not stated in the abstract, and clinical pregnancy and implantation endpoints were limited by few studies and study design variability.