Research progress on effects of per- and polyfluoroalkyl substances on female reproductive health

Per- and polyfluoroalkyl substances (PFASs) represent a group of organic chemicals with structures consisting of fluorinated carbon backbone in different lengths, and they are bioaccumulative and endocrine-disrupting. Humans can be exposed to PFASs through a variety of routes such as inhalation, ingestion, and dermal contact. Population studies have found that PFASs can be detected in urine, blood, and follicular fluid from females. Toxicological studies have demonstrated that PFASs can cause adverse reproductive health outcomes, including decreased fertilization and implantation rate, disturbance of reproductive hormone levels, abnormal egg cell development, and abnormal fetal absorption and fetal development. Limited epidemiological studies have also revealed that exposure to environmental levels of PFASs is related to female reproductive health, but the conclusions remain inconsistent. This study aimed to review the PFAS exposure levels and epidemiological research results from different biological samples in the female population, as well as the female reproductive toxicity and mechanisms of PFASs, and further elaborate the effects of environmental PFAS exposure on female reproduction health.