Population exposure to bisphenol Α and tobacco smoke: Implications for in vitro fertilization treatment

Background: Israel has amongst the highest rates of in vitro fertilization (IVF) treatment in the world, associated with high economic burden for the health system. Exposure to bisphenol A (BPA), active or passive smoking, has been recently associated with poorer early reproductive health outcomes in women undergoing IVF treatment. Human biomonitoring is considered the best method for evaluating exposure to BPA and tobacco smoking (by cotinine measurement). Study Question: What is the proportion of women undergoing IVF in Israel that is likely to benefit from reducing exposure to BPA and smoking in terms of early reproductive outcomes? Methods: We calculated urinary concentrations of BPA and cotinine in women of reproductive age (15-44 years) in the Ministry of Health Human Biomonitoring study, conducted among a population sample of 250 Israeli adults in 2011. We evaluated possible implications for reducing exposure to BPA and smoking among women undergoing IVF treatment in Israel, based on the literature on environmental exposure and IVF outcomes. Results: Assuming that women in Israel undergoing IVF have urinary BPA concentrations similar to those in our study, we predict significantly decreased number of oocytes and decreased blastocyst formation in 40% women undergoing IVF in Israel. Among women at reproductive age, 56.3% of non-smokers had urinary cotinine levels above level of quantification, reflecting widespread second hand smoking exposure. In addition, at least 10% of Israeli women receiving IVF treatment are active smokers, according to a recent report. Conclusions: A significant portion of Israeli women undergoing IVF treatment are likely to benefit from reducing exposure BPA and first and second-hand smoking. Health policy implications: A preventative approach, including counseling to reduce exposure to BPA and smoking for women undergoing IVF treatment, and possibly all women trying to conceive, should be considered and evaluated in Israel and other countries.