Association between serum uric acid to high-density lipoprotein cholesterol ratio and female infertility in women aged 18 to 45 years: A study based on NHANES 2013 to 2018

The uric acid (UA) to HDL-cholesterol ratio (UHR) has recently been proposed as a novel marker of cardiometabolic and inflammatory risk. This study aimed to investigate the association between UHR and infertility in U.S. women of reproductive age. We analyzed data from 2447 women aged 18 to 45 years in the National Health and Nutrition Examination Survey (NHANES) 2013 to 2018 cycles. The primary outcome - infertility - was assessed based on self-reported responses from the reproductive health questionnaire of the National Health And Nutrition Examination Survey dataset, and was not clinically validated. UHR was calculated as the ratio of serum UA to HDL-C. Multivariable logistic regression models were constructed to evaluate the association between UHR and infertility risk. Women with infertility had significantly higher mean age, body mass index, UA levels, and log (UHR) values compared to non-infertile participants (all P <.01). In the fully adjusted model, each unit increase in log-transformed UHR was associated with a higher odd of infertility (OR = 2.04, 95% CI: 1.28-3.27, P = .01). Compared with the lowest quartile of UHR, the adjusted odds ratios for infertility were 1.72 (95% CI: 1.09-2.72) for Q2, 1.91 (95% CI: 1.17-3.12) for Q3, and 1.98 (95% CI: 1.15-3.41) for Q4 (P for trend = .017). Subgroup analyses revealed consistent associations across women aged ≥35 years, those living with a partner, never-smokers, women without diabetes mellitus or hypertension, and those with regular menstrual periods or a history of pelvic infection, although no significant interactions were observed. Elevated UHR is associated with an increased risk of infertility in reproductive-aged women, as observed in this cross-sectional analysis. However, due to the study's cross-sectional nature, causality cannot be inferred, and further prospective studies are needed to validate these findings.