Elevated follicular fluid concentrations of ultraviolet filters associated with diminished ovarian reserve: A case-control study

Ultraviolet filters (UVFs) are widely used in personal care products, their occurrence in the environment and potential detrimental effects on human health have raised significant concerns. This case-control study included 102 women-34 with diminished ovarian reserve (DOR) and 68 healthy controls-and aimed to investigate the association between UVF exposure and DOR. We collected and analyzed follicular fluid (FF) samples from women diagnosed with DOR and compared them to samples from a control group, measuring the concentrations of 16 different UVFs. Four individual compounds showed significantly higher concentrations in the DOR group: octyl methoxycinnamate (OMC), UV-P, UV-328, and Ensulizole. The cumulative concentration of ten UVFs with detection frequencies above 50 % was also markedly elevated in the DOR group (median ΣUVFs: 178.96 ng/mL vs. 23.93 ng/mL, p < 0.001). OMC exhibited the highest median concentration (170.81 ng/mL in DOR vs. 20.77 ng/mL in controls, p < 0.001), followed by UV-P, UV-328, and Ensulizole. Spearman analysis revealed significant negative correlations between OMC concentrations with ovarian reserve biomarkers such as anti-Müllerian hormone (AMH), antral follicle count (AFC), and the number of oocytes retrieved during ovarian stimulation cycles, while exhibiting a positive correlation with follicle-stimulating hormone (FSH) levels. Adjusted logistic regression models demonstrated that elevated OMC levels were associated with a 3.8-fold increased risk of DOR (95 % CI: 1.943-9.782, p < 0.001). These results highlight the urgent need for further investigation into the mechanisms by which UVFs affect ovarian reserve, as well as their potential long-term implications for fertility.