Endometriosis is one of the main causes for
female infertility. Previous studies suggested that perfluoroalkyl substances (PFASs), a group of ubiquitous environmental chemicals with properties of endocrine disruption and reproductive toxicity, were risk factors for
endometriosis but there lacks direct evidence on the possible role of PFASs in
endometriosis-related
infertility. To fill this gap, we examined the association between PFASs and
endometriosis-related
infertility among Chinese reproductive-age women in a case-control study, which comprised 157 surgically confirmed
endometriosis cases and 178 controls seeking
infertility treatment because of male reproductive dysfunction in 2014 and 2015. Blood specimens were collected at the enrollment and analyzed for ten PFASs. Logistic regression was utilized to estimate the adjusted odds ratios (OR) and 95% confidence intervals (CI) for individual PFAS compound. Plasma concentrations of
perfluorobutane sulfonic acid (PFBS) were associated with an increased risk of
endometriosis-related
infertility (second vs. lowest tertile: OR=3.74, 95% CI: 2.04, 6.84; highest vs. lowest tertile: OR=3.04, 95% CI: 1.65, 5.57). This association remained consistent when we restricted to subjects with no previous pregnancy (second vs. lowest tertile: OR=2.91, 95% CI: 1.28, 6.61; highest vs. lowest tertile: OR=3.41, 95% CI: 1.52, 7.65) or to subjects without other gynecologic pathology (second vs. lowest tertile: OR=4.65, 95% CI: 2.21, 9.82; highest vs. lowest tertile: OR=3.36, 95% CI: 1.58, 7.15). Plasma concentrations of
perfluoroheptanoic acid (PFHpA),
perfluorohexane sulfonic acid (PFHxS) and
perfluorononanoic acid (PFNA) were inversely associated with
endometriosis-related
infertility, but the associations were attenuated in the sensitivity analyses. Our preliminary evidence suggests that exposure to PFBS may increase the risk of
female infertility due to
endometriosis. Future prospective studies are necessary to confirm these findings.