|Reproductive effects of BPA|
- Related to early onset of puberty|
▪ Earlier age of vaginal opening in female mice .
▪ Increased uterine and ovarian volume in young female humans .
- Alter mammary gland development
▪ Larger and more abundant terminal end buds in relation to ducts, decreased apoptotic activity, slowed ductal invasion of the stroma, and increased lateral branching in mammary glands of female mice .
▪ Altered rates of ductal migration into the stroma, increase in the percentage of ducts, terminal ducts, terminal end buds, and alveolar buds; an increase in secretory products within the alveoli of female mice .
- Associated with poorer outcome following assisted reproductive technology
▪ Lower number of oocytes retrieved, fewer mature metaphase II oocytes, fewer normally fertilized oocytes, lower serum E2 levels, and a trend for having lower blastocyst formation in women .
▪ Poorer ovarian response, as reflected by fewer oocytes retrieved per cycle and lower serum E2 levels; reduced oocyte maturation and lower fertilization rates in women .
- Role in the pathophysiology of PCOS|
▪ Associated with higher levels of both testosterone and androstenedione, as well as insulin resistance, in women with PCOS .
▪ Additionally, higher levels of DHEA in women with PCOS in another study .
- Alters ovarian steroidogenesis (increase testosterone production)
▪ PCOS studies: androgen levels (seen above) [28, 29].
▪ IVF studies: E2 levels (seen above) [24, 25]
- Associated with increased risk of recurrent miscarriages
▪ Higher BPA levels in women with 3 or more consecutive 1st trimester miscarriages than in healthy woman .
▪ Higher urinary BPA levels correlated with a 3–9 times increased risk of recurrent miscarriages in women .
|Reproductive effects of phthalates|
-Increase reactive oxygen species|
▪ MEHP induced oxidative stress by disrupting the activity and the expression of the antioxidant enzymes SOD1 and GPX; also inhibited the expression of Ccnd2, Ccne1, Cdk4, and Bcl-2, but increased Bax expression in the ovarian follicles of female mice .
-Alter cell cycle regulation and apoptosis
▪ High doses of MEHP inhibited granulosa cell viability and increased apoptosis rates in the ovaries of female mice [43, 44].
-Negatively correlated with ovarian reserve
▪ Higher levels of urinary phthalate concentrations negatively correlated with antral follicle count in infertile women .
- Elevated in endometriosis
▪ Women with endometriosis had significantly higher levels of phthalate metabolites in three different studies [58,59,60].
-Alters ovarian steroidogenesis and folliculogenesis|
▪ Under high concentrations of MEHP, progesterone levels were markedly increased while androstenedione, testosterone, and E2 levels were significantly decreased in female mice .
▪ DEHP significantly inhibited progesterone secretion in a dose-dependent manner, increased plasma prostaglandin F2-alpha levels, downregulated CYP11A, 3β-HSD, and StAR, reduced the numbers and sizes of corpora lutea, and inhibited CD31 expression of corpora lutea in female mice .
▪ MEHP decreased testosterone, estrone, and E2 levels by downregulating mRNA levels of the enzymes: 17alpha-hydroxylase-17,20-desmolase, 17beta-hydroxysteroid dehydrogenase, and aromatase in female mice .
|Reproductive effects of PFAS|
-Alters mammary gland development|
▪ Relationship between PFOA exposure and mammary gland development in female mice [64, 65].
▪ Delay in vaginal opening female mice 
-Alters ovarian steroidogenesis
▪ Decrease in ER-α and ER-β expression in the rat ovary 
▪ Decrease in serum E2 levels in female rats 
-Alters reproductive hormone levels
▪ Serum POFA, PFOS and PFDA levels were negatively associated with serum levels of SHBG, FSH and testosterone in female humans .
▪ Total testosterone concentrations were higher in daughters with prenatal exposure to PFOS or PFOA in female humans .
-Increased rates of infertility
▪ Women with higher serum PFOA levels  and higher PFNA levels  had higher rates of subfecundity
▪ Women with higher serum PFOA levels had longer time to achieve a pregnancy 
▪ Women with the highest PFOA exposure had increased rates of menstrual cycle irregularities .
-Association with miscarriage risk
▪ No association between serum PFOA or serum PFOS levels with miscarriage rate in women .
▪ Little evidence for an association between serum levels of PFOA and miscarriage rate in women .