Per- and Polyfluoroalkyl Substances and Phthalate Metabolites in Follicular Fluid of Women Undergoing In Vitro Fertilization in Nebraska, USA

ABSTRACT Per- and polyfluoroalkyl substances (PFAS) and phthalate metabolites remain understudied in follicular fluid of women undergoing assisted reproduction. We characterized these chemicals in previously collected follicular fluid from patients receiving fertility care at a Nebraska clinic (August 2022-June 2025) and linked exposure data with demographics and clinical characteristics from health records. Spearman correlations and nonparametric tests evaluated PFAS-phthalate relationships and exposure differences by age, race, BMI, and urbanicity. Seven PFAS and four phthalate metabolites were detected in at least half of participants. PFOS and PFHxS concentrations were higher in younger women, and mono-isobutyl phthalate (MiBP) concentrations were higher in younger and non-White women. PFAS-phthalate correlations were weak and did not vary by urbanicity. These results characterize follicular fluid exposure patterns in a Midwestern cohort.