Effect of Bisphenol A Level In Serum and Follicular Fluid On ICSI Outcome.

Infertility is the disability of a couple to obtain pregnancy after one year of sexual intercourse that is unprotected and regular. Bisphenol A is an industrial chemical spread worldwide, that is a raw material utilized in multiple industries. Bisphenol A is assorted as an endocrine-disrupting chemical, which can interfere with hormone activity. This study aimed to assess the effect of BPA levels in serum on ICSI outcomes. The study was conducted at the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies / Al-Nahrain University during the period from October 2021 to April 2022. sixty infertile women enrolled in this study. BPA levels were analyzed through an enzyme-linked immunosorbent assay (ELISA) technique. Mean serum BPA was not significantly higher in non-pregnant women in comparison with that of pregnant women. Serum BPA was positively correlated to immature oocytes (MI) and abnormal oocytes. Also, BPA inversely correlated to Grade1 embryos and positively correlated to Grade 3 embryos. Bisphenol A can be detected in sera of infertile female undergoing ICSI. High BPA level in serum may impact oocyte quality and embryo grading


Introduction
Over time and with recurrent exposure to heat, these products can leach BPA into food and liquids (Brede et al. 2003 [7]).Food ingestion is the main source of human exposure to BPA (Chen et al. 2016 [8]).

1-Demographic characteristics of pregnant and non-pregnant women:
Sixty women accepted to participate in this study; twenty-two of them were pregnant, and the rest thirty-eight were non-pregnant.The mean age of pregnant women was 34.27±1.12yearsand that of women who failed to get pregnant was 32.32±0.85years; there was no significant difference in mean age between pregnant and nonpregnant women (P = 0.16).The mean BMI of pregnant ladies was 28.5±3.67 kg/m2, and that of non-pregnant was 27.37±3.53kg/m2; there was no significant difference in mean BMI between the two groups (P = 0.40).
There was no significant difference between the two groups in the

4-Correlations of serum level of Bisphenol A with the number of oocytes and oocytes quality:
There was no significant correlation of serum Bisphenol A with the total number of oocytes, MII, GV oocytes, maturity index, and fertilization rate.
Serum BPA is positively correlated with MI and abnormal oocytes.

5-Correlations of serum level of Bisphenol A with the embryo transfer and embryo quality:
There

6-Conclusion
In It has been noticed there was an elevation in the infertility rate during the last decades (Vasilopoulos et al. 2019 [2]), which may be related to the Industrial Revolution and growing environmental contamination (Tsatsakis et al. 2019 [3]).One of these interested contaminants is Bisphenol A. It is an organic synthetic compound that was made for the first time in 1891 by Alexander P. Dianin.BPA is widely used as stuff in multiple industries, like the internal coating of food cans and water bottles (Ohore & Zhang, 2019 [4]).BPA has estrogenic features, so it is categorized as an endocrine-disrupting chemical (EDC)

4 embryos. 1 - 2 -
All participants were received written informed consent after an explanation of the study procedure.They were subjected to routine fertility workups before ovarian stimulation to know their fitness to share in the study .Flexible GnRH antagonist protocol for controlled ovarian hyperstimulation (COH) were applied for all participants, in which recombinant FSH (Gonal F, 75IU) was initiated on day 2 of the cycle.When the largest follicle reached a diameter of 12-14 mm, the GnRH antagonist (Cetrotide) was administered in a dose of 0.25 mg daily until three or more follicles attained a 17mm diameter or more.At this time, the ovulation is provoked by the administration of 250 μg human and embryos, and embryo transfer.The end of the study period was defined as a positive or negative pregnancy test according to routine clinical practice.Measurement of Bisphenol A in serum: On the day of oocyte retrieval, 5 ml of venous blood were sampled from women.The blood samples were centrifuged, and serum samples were stored in -20℃ to be used later for measurement of bisphenol A (BPA).kit was purchased from My Bio Source® and labeled as a human Bisphenol ELISA kit.Statistical analysis: Data were collected, summarized, analyzed, and presented using the statistical package for social sciences (SPSS) version 26 and Microsoft Office Excel 2016.Qualitative (categorical) variables were expressed as numbers and percentages, whereas quantitative (numeric) variables were expressed as means and standard Error of Mean (SEM) for continuous measurements.The t-test was done for the comparison between http://doi.org/10.28969/IJEIR.v12.i1.r1.22 et al., Sarah 5 pregnant and non-pregnant ladies regarding the mean age, mean BMI, oocyte characteristics, fertilization rate, embryo quality, and the levels of Bisphenol A. On the other hand, the comparison between pregnant and nonpregnant ladies regarding (different categories of type and causes of infertility, residency, educational level, occupation, and use of canned food) was done using chi-square.The probability value (P value) less than or equal to 0.05 was set as statistically significant.In order to detect the cutoff value that predicts a positive finding, receiver operator characteristic (ROC) curve analysis was used with its corresponding area under the curve (AUC), accuracy level, sensitivity, specificity, and level of significance (P).

6 ( 13 . 2 -
proportions of women according to their residency (rural or urban) (P=0.87), the educational level (primary, secondary, or high education) (P=0.25),their occupation (employee or housewife) (P=0.29), and their usage of canned food (P=0.22).Also, there was no significant difference in the proportions of women with primary or secondary infertility in either group,19 http://doi.org/10.28969/IJEIR.v12.i1.r1.22 et al., Sarah 6%) versus 7 (18.4%),respectively (P = 0.63).Serum Bisphenol A in pregnant and non-pregnant groups: The mean level of the serum Bisphenol A of pregnant and non-pregnant women showed no significant statistical differences.Mean serum BPA was not significantly higher in non-pregnant women in comparison with that of pregnant women, 35.91±3.18ng/ml versus 35.47±3.10ng/ml, respectively (P = 0.92) To obtain a cutoff value for the level of serum bisphenol A that predicts a positive pregnancy outcome with a certain level of accuracy, a receiver operator characteristic (ROC) curve analysis was carried out.The cutoff value of serum bisphenol A was >42.8ng/ml with sensitivity and specificity levels of 36.36% and 89.47%, respectively; the cutoff value had a non-significant level (P = 0.667).

Figure ( 1 )
Figure (1): ROC curve of serum BPA as a predictor of pregnancy

Table ( 4
): Correlations of serum Bisphenol A with the number of oocytes and oocyte quality

et al., Sarah 9Table ( 5
): Correlations of serum level of Bisphenol A with the embryo transfer and embryo quality