A Pilot Study Beyond Ovarian Reserve: How AMH Levels Shape the Proteomic and Metabolic Landscape of the Follicle

The follicular fluid (FF) microenvironment critically influences oocyte development, with Anti-Müllerian Hormone (AMH) serving as a primary marker of ovarian reserve. This exploratory pilot study investigates the biochemical and proteomic shifts across the AMH spectrum to provide initial insights into potential targeted intrafollicular strategies.

FF samples from 49 patients undergoing assisted reproduction were grouped into Low-, Normal-, and High-AMH groups. Oxidative stress, antioxidant capacity, and metabolic indicators (lactate, adiponectin) were analyzed. Proteomic profiling was performed via LC-ESI-MS/MS, followed by STRING network and Spearman correlation analyses.

Distinct molecular shifts occurred across groups. The High-AMH group showed a marked oxidative imbalance. Conversely, the Low-AMH group exhibited a distinct signature with higher lactate, lower adiponectin, and downregulated immunoglobulins, alongside upregulated HRG, ITIH3, and GPLD1. Positive correlations between adiponectin and immunoglobulins in Low-AMH subjects suggest that metabolic and immune-related factors may be coordinately regulated.

This study suggests that AMH levels are associated with specific follicular microenvironment shifts. Low AMH levels appear linked to a distinct profile characterized by immune and metabolic alterations. These findings provide an exploratory foundation for future larger-cohort investigations into follicular homeostasis.