Association between different atherogenic and insulin resistance indices and infertility in polycystic ovary syndrome patients

BACKGROUND: This study aimed to assess the association between multiple atherogenic and insulin resistance indices-including TyG, TyG-BMI, AIP, TG-HDL, and METS-IR-and infertility in women with PCOS, and to evaluate their clinical utility. METHODS: In this cross-sectional study, we analyzed data from 669 sexually active women aged 18-45 with PCOS treated at a tertiary center in Iran (2021-2023). We compared infertile women with PCOS (≥12 months unsuccessful conception, n = 274) to fertile women with PCOS (n = 395). Logistic regression, restricted cubic spline, and receiver operating characteristic (ROC) analysis were used to assess associations and predictive performance. RESULTS: Infertile women had significantly worse metabolic profiles across all indices (P < 0.001). AIP showed the largest point estimate of association (adjusted OR = 9.065, 95% CI: 1.722-47.721). TG-HDL showed a significant non-linear relationship, with ORs rising steeply up to a ratio of ~2.5. Predictive ability was modest, with AUCs ranging from 0.598 (TyG-BMI) to 0.625 (AIP, TG-HDL). CONCLUSION: Several metabolic indices, particularly AIP, are associated with infertility in women with PCOS, though their standalone predictive utility remains limited.