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5932890 
Journal Article 
The associations of urinary phthalate metabolites with the intermediate and pregnancy outcomes of women receiving IVF/ICSI treatments: A prospective single-center study 
Deng, T; Du, Y; Wang, Y; Teng, X; Hua, X; Yuan, X; Yao, Y; Guo, N; Li, Y 
2020 
Yes 
Ecotoxicology and Environmental Safety
ISSN: 0147-6513
EISSN: 1090-2414 
Academic Press 
SAN DIEGO 
188 
109884 
English 
31706241 
WOS:000503913900059 
BACKGROUND: Phthalate exposure was reported to induce defects in ovarian function, and further influence embryo development and pregnancy outcomes. However, the data about the associations of phthalates with intermediate and pregnancy outcomes of in vitro fertilization (IVF) cycles are scarce in the Chinese population.

METHODS: A total of 663 women receiving IVF/intracytoplasmic sperm injection (ICSI) treatments in our center were enrolled in this analysis. They provided one urine sample on the day of oocyte retrieval. We measured urinary concentrations of eight phthalate metabolites. Generalized linear models were used to analyze the associations of urinary phthalate metabolites with ovarian response, fertilization, early embryo development, and pregnancy outcomes.

RESULTS: Among all the phthalate metabolites, mono-n-butyl phthalate (MBP) had the highest urinary concentration with a median level of 101.51 μg/g creatinine (Cr). MBP concentration was inversely associated with normal fertilization odds (overall P-trend < 0.01). There was a significant correlation of monoethyl phthalate (MEP) with decreased odds of normal fertilization in medium-concentration group compared to low-concentration group (overall P-trend = 0.02). No significant associations of metabolite concentrations with the odds of good-quality embryos on day 3 or blastocyst formation were found. Monomethyl phthalate (MMP) and MEP in medium-concentration group reduced 22.4% (95% CI: 0.64-0.94, overall P-trend = 0.04) and 21.9% (95% CI: 0.64-0.95, overall P-trend = 0.05) of the odds to gain good-quality blastocyst compared to low-concentration group. The eight phthalate metabolites were not correlated to clinical pregnancy rate, live birth rate, or early miscarriage rate. There was no significant association of di (2-ethylhexyl) phthalate (DEHP) metabolites observed with any clinical outcomes in the total population. After excluding male infertility, mono (2-ethyl-5-hydroxyhexyl) phthalate (MEHHP) in medium-concentration group turned to be associated with a higher number of retrieved oocytes (overall P-trend = 0.04), whereas mono (2-ethyl-5-oxohexyl) phthalate (MEOHP) in medium-concentration group was associated with a lower odds of normal fertilization compared to low-concentration group (overall P-trend = 0.02).

CONCLUSIONS: Urinary MBP concentration was much higher compared to other phthalate metabolites in this cohort of Chinese IVF/ICSI women, and also higher than it was reported by studies in other countries. MBP showed adverse impacts on fertilization. MMP and MEP could affect blastocyst quality, but not embryo quality on day 3. DEHP metabolites didn't show consistent reproductive toxicities as demonstrated in previous studies. 
Early embryo development; Fertilization; In vitro fertilization; Phthalate metabolite; Pregnancy outcome; mono (2 ethyl 5 hydroxyhexyl) phthalate; mono (2 ethyl 5 oxohexyl) phthalate; mono n butyl phthalate; mono n octyl phthalate; monobenzyl phthalate; monoethyl phthalate; monomethyl phthalate; phthalic acid 2 ethylhexyl monoester; phthalic acid bis(2 ethylhexyl) ester; phthalic acid derivative; unclassified drug; phthalic acid; phthalic acid derivative; cohort analysis; concentration (composition); fertilization (reproduction); metabolite; phthalate; pregnancy; reproductive health; urine; adult; Article; birth rate; blastocyst; Chinese; clinical outcome; concentration (parameter); correlational study; embryo development; exposure; female; human; in vitro fertilization; intracytoplasmic sperm injection; oocyte retrieval; pregnancy; pregnancy rate; prospective study; spontaneous abortion; urine level; adverse event; China; drug effect; epidemiology; fertilization; maternal exposure; metabolism; pollutant; pregnancy; pregnancy outcome; toxicity; urine; China; Adult; China; Embryonic Development; Environmental Pollutants; Female; Fertilization; Fertilization in Vitro; Humans; Maternal Exposure; Phthalic Acids; Pregnancy; Pregnancy Outcome; Prospective Studies 
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