title: Perfluoroalkyl substances and time to pregnancy in couples from Greenland, Poland and Ukraine.
abstract: BACKGROUND
  Perfluoroalkyl substances (PFAS) are suggested to affect human fecundity through longer time to pregnancy (TTP). We studied the relationship between four abundant PFAS and TTP in pregnant women from Greenland, Poland and Ukraine representing varying PFAS exposures and pregnancy planning behaviors.
  
  
  METHODS
  We measured serum levels of perfluorooctanoic acid (PFOA), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonic acid (PFHxS) and perfluorononanoic acid (PFNA) in 938 women from Greenland (448 women), Poland (203 women) and Ukraine (287 women). PFAS exposure was assessed on a continuous logarithm transformed scale and in country-specific tertiles. We used Cox discrete-time models and logistic regression to estimate fecundability ratios (FRs) and infertility (TTP >13 months) odds ratios (ORs), respectively, and 95% confidence intervals (CI) according to PFAS levels. Adjusted analyses of the association between PFAS and TTP were done for each study population and in a pooled sample.
  
  
  RESULTS
  Higher PFNA levels were associated with longer TTP in the pooled sample (log-scale FR = 0.80; 95% CI 0.69-0.94) and specifically in women from Greenland (log-scale FR = 0.72; 95% CI 0.58-0.89). ORs for infertility were also increased in the pooled sample (log-scale OR = 1.53; 95% CI 1.08-2.15) and in women from Greenland (log-scale OR = 1.97; 95% CI 1.22-3.19). However, in a sensitivity analysis of primiparous women these associations could not be replicated. Associations with PFNA were weaker for women from Poland and Ukraine. PFOS, PFOA and PFHxS were not consistently associated with TTP.
  
  
  CONCLUSIONS
  Findings do not provide consistent evidence that environmental exposure to PFAS is impairing female fecundity by delaying time taken to conceive.
authors.affiliation: Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark. kristiantore@hotmail.com.
authors.forename: Kristian T
authors.initials: KT
authors.lastname: Jørgensen
authors.affiliation: Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark. ina.olmer.specht@regionh.dk.
authors.forename: Ina O
authors.initials: IO
authors.lastname: Specht
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. V.C.Lenters@uu.nl.
authors.forename: Virissa
authors.initials: V
authors.lastname: Lenters
authors.affiliation: Perinatal Epidemiology Research Unit, Aarhus University Hospital, Skejby, Denmark. cathrine_c_bach@hotmail.com.
authors.forename: Cathrine C
authors.initials: CC
authors.lastname: Bach
authors.affiliation: Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Lars.Rylander@med.lu.se.
authors.forename: Lars
authors.initials: L
authors.lastname: Rylander
authors.affiliation: Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Bo_A.Jonsson@med.lu.se.
authors.forename: Bo A G
authors.initials: BA
authors.lastname: Jönsson
authors.affiliation: Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden. Christian.Lindh@med.lu.se.
authors.forename: Christian H
authors.initials: CH
authors.lastname: Lindh
authors.affiliation: Reproductive Medicine Centre, Malmö University Hospital, Lund University, Malmö, Sweden. Aleksander.Giwercman@med.lu.se.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Giwercman
authors.affiliation: Division of Environmental Epidemiology, Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands. d.heederik@uu.nl.
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
authors.affiliation: Department of Occupational Medicine, Danish Ramazzini Center, Aarhus University Hospital, Aarhus, Denmark. gunntoft@rm.dk.
authors.forename: Gunnar
authors.initials: G
authors.lastname: Toft
authors.affiliation: Department of Occupational and Environmental Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Copenhagen, Denmark. jpb@bbh.regionh.dk.
authors.forename: Jens Peter
authors.initials: JP
authors.lastname: Bonde
mesh_terms: D000328:Adult; D017738:Alkanesulfonic Acids / Q000097:blood*; D002210:Caprylates / Q000097:blood*; D004785:Environmental Pollutants / Q000097:blood*; D005191:Family Characteristics; D005227:Fatty Acids; D005260:Female; D005466:Fluorocarbons / Q000097:blood*; D006116:Greenland; D006801:Humans; D008297:Male; D011044:Poland; D011247:Pregnancy; D013451:Sulfonic Acids / Q000097:blood*; D061685:Time-to-Pregnancy; D014455:Ukraine
chemical_list: D017738:Alkanesulfonic Acids; D002210:Caprylates; D004785:Environmental Pollutants; D005227:Fatty Acids; D005466:Fluorocarbons; D013451:Sulfonic Acids; C471071:perfluorohexanesulfonic acid; C101816:perfluoro-n-nonanoic acid; C023036:perfluorooctanoic acid; C076994:perfluorooctane sulfonic acid