Implications of triclosan for female fertility: results from the National Health and Nutrition Examination Survey, 2013–2016

OBJECTIVE: To examine and further characterize the association between urinary levels of triclosan (TCS), a ubiquitous putative endocrine-disrupting chemical, and the risk of infertility. DESIGN: A retrospective cross-sectional study using the Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey. SETTING: Not applicable. PATIENT(S): Female participants in the United States who completed the reproductive health questionnaire and provided urine samples for TCS level measurement from 2013 to 2016. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Rates of presumed infertility based on participants’ affirmative response to survey question RHQ074 (“Have you ever attempted to become pregnant over a period of at least a year without becoming pregnant?”). RESULT(S): A total of 11.7% of the overall female and 12.5% of the eligible study population met the criterion for presumed infertility. Creatinine-adjusted urinary TCS levels were significantly higher among those meeting the criterion for infertility compared with the levels among those who did not. On multivariable-adjusted analyses, individuals with undetectable levels of urinary TCS were 35% less likely to meet the specified infertility criterion compared with those with detectable TCS levels. The magnitude of association between TCS levels and infertility was strongest when comparing the lowest and highest quartiles. The directionality and magnitude of the relationship between TCS levels and infertility were maintained on age-restricted and weighted analyses; however, the associations did not retain statistical significance. CONCLUSION(S): In a nationally representative sample of women in the United States, an association between TCS exposure and inability to conceive over a period of 1 year is suggested by our analysis of the National Health and Nutrition Examination Survey data. The data infer a dose-response relationship.