PFAS exposure and reproductive dysfunction: implications for outcomes in assisted reproductive technologies

The high stability and bioaccumulation potential of per- and polyfluoroalkyl substances (PFAS) have led to their widespread environmental presence and raised concerns about human health exposure through multiple pathways. In particular, PFAS exposure during assisted reproductive technology (ART) has attracted increasing attention from the scientific community. Current evidence indicates that PFAS may be associated with diminished fertility, adverse pregnancy outcomes, and impaired fetal health, although the underlying mechanisms remain incompletely elucidated. Emerging studies suggest that these effects may arise from multi-level disruptions of the reproductive system, including interference with hypothalamic-pituitary-gonadal axis regulation, steroidogenesis, gamete quality, oxidative stress and inflammatory signaling, as well as compromised endometrial receptivity and placental function. This review synthesizes and analyzes existing research to explore the impact of PFAS on reproductive outcomes following ART. It highlights potential risks to reproductive health and offers updated perspectives for researchers and public health policymakers.