The impact of polycyclic aromatic hydrocarbon metabolites on reproductive hormone levels and follicle count in patients with polycystic ovary syndrome: a case-control study

Polycystic ovary syndrome (PCOS) is a common endocrine disorder in women of reproductive age, potentially influenced by environmental factors like polycyclic aromatic hydrocarbons (PAHs). Limited data exist on how PAH exposure affects reproductive health and its association with PCOS. This study investigates the association between urinary PAH metabolites, reproductive hormone levels, and antral follicle count (AFC) in PCOS patients. This case-control study involved 63 PCOS patients and 91 controls. Serum levels of anti-Müllerian hormone (AMH), testosterone (T), luteinizing hormone (LH) and total AFC were significantly elevated in patients with PCOS compared to the control group. Logistic regression analysis revealed that elevated 9-hydroxyfluorene exposure was associated with increased odds of PCOS case status. Poisson regression analysis found significant positive associations between 9-hydroxyphenanthrene and total AFC, as well as 6-hydroxychrysene and total AFC. Linear regression analysis showed positive associations between total hydroxylated PAHs (ΣOHPAHs) and LH levels, as well as between total hydroxylated naphthalene and LH levels. Poisson regression indicated positive associations between AMH, LH and T with total AFC. Mediation analysis indicated LH significantly mediates the relationship between ΣOHPAHs and total AFC. These findings indicate that PAH exposure may harm ovarian reserve and reveal new links between environmental PAHs and PCOS.