Elevated log uric acid-to-high-density lipoprotein cholesterol ratio (UHR) as a predictor of increased female infertility risk: insights from the NHANES 2013-2020.

Background: Infertility is a multifaceted condition influenced by metabolic and biochemical factors. Uric acid (UA) and high-density lipoprotein cholesterol (HDL-C) may individually affect reproductive health. The UA-to-HDL-C ratio (UHR), an emerging indicator of chronic inflammation and metabolic status, may be associated with infertility because of its connections to metabolic disorders, disrupted reproductive processes, and other related factors. Nevertheless, evidence of the relationship between the UHR and infertility remains limited and controversial. Therefore, potential associations were analyzed in this study.

Methods: In this cross-sectional study, data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES) were utilized, a nationally representative survey assessing the health and nutritional status of the U.S.

Population: Female participants aged 18-45 years (n = 6502) whose infertility status was determined through self-reported responses to reproductive health questions were included. The primary outcome was infertility, defined on the basis of responses indicating difficulty in conceiving over the past year. Between-group differences were analyzed via Student's t test or the Mann‒Whitney U test for continuous variables or the chi-square test for categorical data. The independent association between infertility status and the log UHR was assessed by log computes logarithms by default natural logarithms. Subgroup analyses were performed to assess the strength of the results.

Results: The mean log UHR of the women in the infertility group was significantly greater than that of the women in the noninfertility group (5.34 vs. 5.22, P < 0.001). Adjusted analyses revealed that an increase in the log UHR was associated with greater odds of infertility (odds ratio (OR) = 1.830, 95% confidence interval (CI) 1.396-2.401). Subgroup analysis revealed that women younger than 35 years with an elevated log UHR faced an even greater risk of infertility (OR = 2.716, 95% CI 1.784-4.162; P < 0.001).

Conclusions: An elevated UHR is associated with a higher risk of infertility, and this knowledge may be beneficial for developing a nonpharmacological intervention for improving fertility outcomes. Further research is needed to clarify the direct impact of the UHR on female infertility, which could inform future strategies for prevention and treatment.