This week, I received an Email which said “We offer a service that we think would benefit your
patients. It is a urine test for toxic chemical exposures, like BPA and phthalates. These are
chemicals that are in everyday products, and can reduce fertility and IVF success.”
I am always looking for ways to boost our IVF success rates
but is there evidence that this kind of urine testing is helpful if you are doing
IVF? Let’s find out! Be sure you watch until the end to hear my InfertilityTV bottom Line
What is BPA? BPA stands for bisphenol A. BPA is an industrial chemical that has been used
to make certain plastics and resins since the 1960s. These plastics and resins are
often found in food containers like water bottles and cans. Some research has shown
that BPA can seep into food or beverages from containers that are made with BPA.
Can you measure BPA exposure with a urine test?
Yes. In humans, BPA is broken down by the liver and rapidly excreted in the
urine. Urinary concentrations of BPA will accurately reflect recent BPA exposure.
Is there any scientific reason that exposure to BPA could be a problem for women trying
to get pregnant? Maybe. Some studies in the laboratory and in mice found that
BPA could cause chromosome abnormalities in eggs and reduce estrogen production.
Is there any evidence that BPA in humans can cause problems with IVF?
Well, in 2009, scientists at Harvard University did a small study of women going through IVF.
They found that women with higher levels of BPA in their urine produced a few less eggs and less
estrogen. Because of their findings in that study, the same group of scientists looked at whether
BPA was associated with IVF implantation failure. Implantation failure is when a woman has an embryo
placed into the uterus but it doesn’t implant. In other words, she does not get pregnant.
In 2012, they published a study which found that higher BPA levels seemed to be associated
with lower implantation rates. However, they didn’t have quite enough women in the
study to say for sure whether this was real. Therefore, they did an even bigger study with
twice as many women and almost 4 times more IVF cycles. This study, which was published in 2015
is now the largest study of BPA and IVF success to date. Here are the results:
There was no association between BPA levels in the urine and estrogen levels, fertilization rates
or embryo quality. Furthermore, women with high BPA levels had the same implantation rate,
pregnancy rate and live birth rate as women with lower levels. This was sort of surprising
to them so the reanalyzed the data in several different ways. Each time they found the same
results. There was no association between BPA and any of these measures of IVF success.
What about other environmental toxins? Parabens are a group of chemicals that are widely used
in cosmetics, personal care products, medications and food. There is concern about parabens ability
to disrupt how estrogen works in the body. This 2016 study of 245 women in over 350 IVF cycles
found no association between urinary parabens and the number of eggs retrieved during IVF,
fertilization rates, and embryo quality. There was also no association between parabens
and implantation rate, pregnancy rates or live birth rates.
Another group of environmental toxins are called phthalates. Phthalates, like parabens are found in
a variety of products like body lotions, cosmetics shampoos and deodorants. Like the other chemical
we discussed, phthalates are rapidly broken down in the body and excreted in the urine.
Remember the scientists we talked about earlier from Harvard who did the BPA study? That data came
out of a longer term study called the EARTH study which stands for Environment and Reproductive
Health. They also looked at the impact of 11 different urinary phthalate breakdown products,
what we call metabolites, on IVF success. Two phthalate metabolites were found to be associated
with a decreased number of eggs produced at egg retrieval. Two were associated with a reduced
fertilization rate and four were associated with a reduction in pregnancy rates and live birth rates.
These were meaningful differences. Overall, the live birth rate dropped from about 45%
in those women with the lowest levels to about 30% in those with the highest levels.
Our InfertilityTV Bottom Line is this: Some types of chemicals like BPA and parabens
do not seem to be related to IVF success. Some types of phthalates, but not others,
do seem to reduce IVF success. Should you get a urine toxin test? Well, first of all, they are
pretty expensive. We don't have any studies which show that doing these tests and adjusting your
lifestyle will actually improve your IVF success. Plus, you will have to pay for more tests to see
if your changes are working to lower your levels. Remember, these chemicals are everywhere. It just
may not be possible to avoid them enough to make a difference. Instead of spending
hundreds of dollars on urine testing, maybe just try following some free tips on reducing
your phthalate exposure like the ones in this article. I’ll put the link in the description.