KARU FERTIL

The objectives of this project are to study the association between chlordecone exposure and female infertility especially ovarian reserve markers (AMH and antral follicle count (AFC)) and to study the social impact of chlordecone, through the experience and representation of infertile women and healthcare workers managing infertile couples. Our project is thus built upon two complementary approaches: an epidemiological and a sociological approaches. All women aged from 18 to 39 years and consulting for couple infertility at the Caribbean Center for Reproductive Medicine of the University Hospital of Guadeloupe will be eligible to participate in the epidemiological study. In their routine workup, all women will have AMH measurements and a transvaginal echography for AFC. At inclusion, all medical conditions potentially related to female and male infertility will be recorded and women will complete a questionnaire. Blood samples will be collected at the same time to measure plasma chlordecone by HPLC coupled with MS/MS. Ovarian reserve markers will be analysed as a continuous variable using multiple linear regressions (AMH) and Poisson regressions (AFC) by examining chlordecone levels adjusted for potential confounders. In addition, as an exploratory analysis, associations between chlordecone and the most frequent medical conditions involved in female infertility will be investigated (polycystic ovary syndrome, endometriosis, diminished ovarian reserve), using cases-controls designs. A total of 634 women will be included in this study to have sufficient power. For the sociological approach, semi-structured interviews will be conducted on a sample of women included in the epidemiological study (expected n=40) and on a sample of healthcare workers (expected n=20) managing couple infertility in Guadeloupe. These interviews will be thematically analyzed to provide a comprehensive analysis of their representations of chlordecone and its impacts on infertility.