Abstract
BACKGROUND: There has been little research on the association of exposure to environmental factors on polycystic ovary syndrome (PCOS), nor on the interaction between environmental factors and liver and kidney function. Anti-mullerian hormone (AMH) has been proposed to add significance to diagnosis of PCOS in case of ambiguity. We hypothesize that long-term inhalation exposure to environmentally relevant levels of these factors may induce changes in hepatic and renal function, thereby exacerbating the risk of developing PCOS. METHODS: The study used a cross-sectional study. Cases were newly diagnosed PCOS patients from a tertiary hospital. Controls were age - and BMI - matched healthy women recruited from the same communities. Data on age and various blood test results were collected from medical records. Meteorological factors and air pollutants were obtained from the National Oceanic and Atmospheric Administration (NOAA). After feature selection, we employed logistic regression, weighted quantile sum (WQS) regression, and neural network models to analyze the associations between relevant variables and the risk characteristics and prediction of PCOS including different aged groups. RESULTS: There were 384 subjects in this retrospective study, randomly including 178 PCOS patients and 206 controls. The levels of most sexual function (FSH, LH, PRL, T, AMH) and liver function indicators (TP, Alb, A/G, ALP, PA, TBA) in PCOS patients were significantly higher than those in the control group. Overall, the AMH level in the PCOS population was 1.133 times that of the non-affected population (95% confidence interval [CI]: 1.077, 1.192). Within the 21–35 years age group, the levels of air pressure and albumin in PCOS patients were 1.060 (95% CI: 1.028, 1.093) and 1.098 (95% CI: 1.002, 1.204) times higher, respectively, than in the non-affected population. Based on the results obtained from the stratified analysis, we incorporated several variables into the prediction model, namely PM₂.₅, air pressure, FSH, PRL, T, AMH, Alb and PA. The overall population demonstrated good PCOS predictive performance in internal validation using the neural network model (test AUC = 0.864, train AUC = 0.992; test R² = 0.342, train R² = 0.910). CONCLUSIONS: Significant elevations in levels of AMH and Alb were detected in women with PCOS. The back-propagation (BP) neural network demonstrated good PCOS predictive performance for the models mediated by environmental factors (PM₂.₅, air pressure). This suggests that these factors may probably exacerbate the effects of sexual function (FSH, PRL, T, AMH) and liver function indicators (Alb, PA) on the risk of developing PCOS. Our results support a potential association between environmental factor exposure and the consequences of PCOS in women. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13048-026-01981-7.