Association of bisphenol A exposure with in vitro fertilization outcomes: A meta-analysis and systematic review

The impact of bisphenol A (BPA) on in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) outcomes remains unclear.

This systematic review and meta-analysis evaluated studies from Pubmed, Web of Science, EMBASE, and Cochrane Library (up to April 19, 2024), analyzing data using regression coefficient (β) and their 95 % confidence intervals (CIs).

A total of 478 references were identified and 14 studies with different IVF/ICSI outcomes were included in the final meta-analysis. The included studies reported that the median or geometric mean (GM) of specific gravity (SG) or creatinine (Cr)-adjusted maternal urinary BPA ranged from 0.063 to 2.61 ng/ml. The meta-analysis results indicated a significant negative correlation between urinary, serum, follicular fluid (FF), and semen BPA exposure and several key IVF/ICSI outcomes, particularly in terms of 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 the subgroup analysis based on BPA exposure level, higher BPA exposure was significantly associated with decreased normal fertilization rate in IVF/ICSI, particularly in populations with BPA median or GM concentrations above 1.55 ng/ml (β: -0.19; 95 % CI: -0.27, -0.11). However, no significant association was observed between BPA exposure and clinical pregnancy rates, blastocyst formation, or implantation success rates, which may be attributed to the limited number of studies and variability in study design and populations.

This meta-analysis suggests that BPA, a common environmental pollutant, may reduce reproductive success during IVF/ICSI by disrupting endocrine function and compromising gamete quality and early embryo development. However, due to study limitations, further research is needed to confirm our findings and explore the mechanisms underlying reproductive toxicity.