Joint association of dietary and lifestyle oxidative balance score with infertility among reproductive-aged US female: a cross-sectional study

Infertility affects one in six individuals globally, with oxidative stress-modifiable through diet and lifestyle-being a key factor in female infertility. This study examines associations between dietary/lifestyle Oxidative Balance Scores (OBS) and infertility risk in reproductive-aged women. Using 2013-2018 NHANES data from 2,447 women aged 20-44, we calculated OBS (16 dietary and 4 lifestyle components) reflecting antioxidant vs. pro-oxidant exposure. Higher scores indicate antioxidant dominance. Weighted logistic regression models adjusted for sociodemographic and health covariates revealed an inverse linear relationship: each 1-unit OBS increase correlated with 4.7% lower infertility risk (95% CI: 0.929-0.977, <i>p</i> < 0.001). Women in the highest OBS tertile had 6.4% reduced odds versus lower tertiles (95% CI: 0.897-0.977, <i>p</i> = 0.003). Joint analyses showed higher lifestyle OBS mitigated infertility risk among women with low dietary OBS. Results remained consistent across subgroups and sensitivity analyses. These findings underscore the potential of antioxidant-rich diets and healthy lifestyles in reducing oxidative stress-related infertility, advocating for targeted interventions to improve reproductive health outcomes.