ORIGINAL RESEARCH article
Front. Endocrinol.
Sec. Reproduction
Association Between PFAS Compounds in Follicular Fluid and POR 1 and the Intervention Effect of Qizi Yusi Tang: A Study Based on 2 Targeted PFAS Quantification Analysis
1. Shandong University of Traditional Chinese Medicine, Jinan, China
2. Tongji University, Shanghai, China
3. Shandong University of Traditional Chinese Medicine Affiliated Hospital, Jinan, China
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Abstract
BackgroundThis study employs high-throughput targeted PFAS quantification analysistargeted metabolomics to analyze per- and polyfluoroalkyl substances (PFAS) metabolites in follicular fluid from women with Kidney Deficiency-Liver Stagnation Pattern poor ovarian response (POR) and IVF controls with normal ovarian reservehealthy controls. Furthermore, we examine PFAS metabolite alterations in POR patients before and after intervention with kidney-tonifying and liver-soothing herbal medicine to validate the syndrome essence of Kidney Deficiency-Liver Stagnation Pattern in POR.suggest that PFAS compounds, particularly PFBA, are significant metabolic markers associated with the Kidney Deficiency-Liver Stagnation Pattern in POR. MethodsThis study enrolled 93 patients undergoing in vitro fertilization and embryo transfer (IVF-ET). Participants were divided into three groups: (1) the non-herbal intervention group (POR-NON group, n =31); (2) the control group (POR-CON group, n =31); and (3) the herbal medicine intervention group (POR-TCM, n =31). And ultra-high performance liquid chromatography-triple quadrupole mass spectrometer (UHPLC-QTRAP MS) was used to detect metabolites in the three groups of samples. ResultsPatients with Kidney Deficiency-Liver Stagnation Pattern POR showed significantly higher levels of PFBA in follicular fluid compared to IVF controls with normal ovarian reservehealthy controls (P < 0.01). The level of PFBA in follicular fluid was significantly lower in patients with Kidney Deficiency-Liver Stagnation Pattern POR who received QZYST intervention (POR-TCM group) than in those who did not receive intervention (POR-NON group) (P < 0.05). QZYST intervention significantly reduced Kidney Deficiency-Liver Stagnation Pattern scores in POR patients compared to both baseline (P < 0.001) and the POR-NON group (P < 0.05). The POR-TCM group demonstrated significantly improved number of oocytes retrieved (P < 0.05) and two-pronuclei (2PN) zygotes (P < 0.05), along with significantly fewer cycles with no transferable embryos (P < 0.05) compared to the POR-NON group. ConclusionsPatients with Kidney Deficiency-Liver Stagnation Pattern POR exhibited significantly elevated levels of PFAS compoundsmetabolites in follicular fluid compared to IVF controls with normal ovarian reservehealthy controls. Compared with the control group, patients who received QZYST intervention showed improvements in TCM syndrome manifestations and key clinical outcomes, and significantly lower PFBA levels were observed in the follicular fluid of the TCM intervention group than in those without intervention.
Summary
Keywords
Non-randomized prospective sequential comparative design, Poor ovarian response, QiziYusi Tang, Targeted per- and polyfluoroalkyl substances analysis, Traditional Chinesemedicine
Received
01 December 2025
Accepted
09 February 2026
Copyright
© 2026 Li, Wen-jing, Hu, Guo, Song and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Jing-Yan Song; Zhen-Gao Sun
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