title: Urinary bisphenol A concentrations and association with in vitro fertilization outcomes among women from a fertility clinic.
abstract: OBJECTIVE
  Are urinary BPA concentrations associated with in vitro fertilization (IVF) outcomes among women attending an academic fertility center?
  
  
  CONCLUSIONS
  Urinary BPA concentrations were not associated with adverse reproductive and pregnancy outcomes among women from a fertility clinic.
  
  
  BACKGROUND
  Bisphenol A (BPA), an endocrine disruptor, is detected in the urine of most Americans. Although animal studies have demonstrated that BPA reduces female fertility through effects on the ovarian follicle and uterus, data from human populations are scarce and equivocal.
  
  
  METHODS
  This prospective cohort study between 2004 and 2012 at the Massachusetts General Hospital Fertility Center included 256 women (n = 375 IVF cycles) who provided up to two urine samples prior to oocyte retrieval (total N = 673).
  
  
  METHODS
  Study participants were women enrolled in the Environment and Reproductive Health (EARTH) Study. Intermediate and clinical end-points of IVF treatments were abstracted from electronic medical records. We used generalized linear mixed models with random intercepts to evaluate the association between urinary BPA concentrations and IVF outcomes adjusted by age, race, body mass index, smoking status and infertility diagnosis.
  
  
  RESULTS
  The specific gravity-adjusted geometric mean of BPA was 1.87 µg/l, which is comparable to that for female participants in the National Health and Nutrition Examination Survey, 2011-2012. Urinary BPA concentrations were not associated with endometrial wall thickness, peak estradiol levels, proportion of high quality embryos or fertilization rates. Furthermore, there were no associations between urinary BPA concentrations and implantation, clinical pregnancy or live birth rates per initiated cycle or per embryo transfer. Although we did not find any associations between urinary BPA concentrations and IVF outcomes, the relation between BPA and endometrial wall thickness was modified by age. Younger women (<37 years old) had thicker endometrial thickness across increasing quartiles of urinary BPA concentrations, while older women (≥37 years old) had thinner endometrial thickness across increasing quartiles of urinary BPA concentrations.
  
  
  CONCLUSIONS
  Limitations to this study include a possible misclassification of BPA exposure and difficulties in extrapolating the findings to the general population.
  
  
  CONCLUSIONS
  Data on the relation between urinary BPA concentrations and reproductive outcomes remain scarce and additional research is needed to clarify its role in human reproduction.
  
  
  BACKGROUND
  This work was supported by NIH grants R01ES022955, R01ES009718 and R01ES000002 from the National Institute of Environmental Health Sciences (NIEHS) and grant T32DK00770316 from the National Institute of Child Health and Human Development (NICHD). None of the authors has any conflicts of interest to declare. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA lminguez@hsph.harvard.edu.
authors.forename: Lidia
authors.initials: L
authors.lastname: Mínguez-Alarcón
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Audrey J
authors.initials: AJ
authors.lastname: Gaskins
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Yu-Han
authors.initials: YH
authors.lastname: Chiu
authors.affiliation: Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Paige L
authors.initials: PL
authors.lastname: Williams
authors.affiliation: Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA.
authors.forename: Shelley
authors.initials: S
authors.lastname: Ehrlich
authors.affiliation: Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Chavarro
authors.affiliation: Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Petrozza
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
authors.forename: Jennifer B
authors.initials: JB
authors.lastname: Ford
authors.affiliation: National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Calafat
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA Vincent Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Russ
authors.initials: R
authors.lastname: Hauser
mesh_terms: D000328:Adult; D001559:Benzhydryl Compounds / Q000009:adverse effects* / Q000652:urine; D004968:Estrogens, Non-Steroidal / Q000009:adverse effects* / Q000652:urine; D005260:Female; D005307:Fertilization in Vitro; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced*; D010636:Phenols / Q000009:adverse effects* / Q000652:urine; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D000098826:Bisphenol A Compounds
chemical_list: D001559:Benzhydryl Compounds; D004968:Estrogens, Non-Steroidal; D010636:Phenols; C006780:bisphenol A; D000098826:Bisphenol A Compounds
keywords: IVF outcomes; bisphenol A; endocrine disruptor; epidemiology; reproductive health