Systemic inflammatory and immunonutritional profile in women with low anti-Müllerian hormone levels

INTRODUCTION: Anti-Müllerian hormone (AMH) is widely used as a biomarker of ovarian reserve. Although systemic inflam-mation and nutritional status may be associated with ovarian function, the relationships of composite inflammatory and nutrition-related indices with low AMH remain incompletely characterized. This study aimed to evaluate systemic inflammatory and nutrition-related indices in women with low AMH levels.
METHODS: A total of 150 women were included, comprising 75 women with low AMH and 75 with high AMH. The neu-trophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), sys-temic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), prognostic nutritional index (PNI), and hemoglobin–albumin–lymphocyte–platelet (HALP) index were evaluated. Associations between continuous AMH concentrations and these indices were assessed using Spearman correlation analysis. Age- and body mass index (BMI)-adjusted logistic regression models were used to evaluate associations with low AMH.
RESULTS: Women with low AMH were older than those with high AMH (33.0 [29.5–36.5] vs. 27.0 [24.0–31.0] years; q<0.001), whereas BMI did not differ significantly between the groups. AISI, SIRI, PLR, NLR, and SII were significantly higher, whereas PNI and HALP were significantly lower, in the low AMH group, with all differences remaining significant after multiple-comparison correction. AMH was inversely correlated with AISI (ρ=-0.282), SIRI (ρ=-0.266), PLR (ρ=-0.257), NLR (ρ=-0.314), and SII (ρ=-0.324), and positively correlated with PNI (ρ=0.466) and HALP (ρ=0.366) (all p≤0.001). After adjustment for age and BMI, higher NLR was associated with greater odds of low AMH (adjusted OR=2.03, 95% CI: 1.34–3.06; p<0.001), whereas higher PNI was associated with lower odds (adjusted OR=0.31, 95% CI: 0.19–0.51; p<0.001).
DISCUSSION AND CONCLUSION: Low AMH was associated with a profile of higher systemic inflammatory indices and lower nutrition-re-lated indices. These associations remained significant after adjustment for age and BMI, supporting an association be-tween low AMH and a distinct systemic inflammatory and immunonutritional profile. Further prospective, multicenter studies are needed to confirm these associations and clarify their biological and potential clinical significance.

Keywords: Anti-Müllerian hormone, HALP, neutrophil-to-lymphocyte ratio, ovarian reserve, prognostic nutritional in-dex, systemic inflammation