Kong Yanxiang, Lin Miaoling, Fu Yiman, Huang Baoyi, Jin Mengqi, Ma Lin
Center for Reproductive Medicine, Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Lipids Health Dis. 2025 Apr 1;24(1):127. doi: 10.1186/s12944-025-02521-w.
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.
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.
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.
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).
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.
不孕症是一种受代谢和生化因素影响的多方面病症。尿酸（UA）和高密度脂蛋白胆固醇（HDL-C）可能分别影响生殖健康。尿酸与高密度脂蛋白胆固醇比值（UHR）作为慢性炎症和代谢状态的新兴指标，可能因其与代谢紊乱、生殖过程中断及其他相关因素的联系而与不孕症有关。然而，UHR与不孕症之间关系的证据仍然有限且存在争议。因此，本研究分析了潜在关联。
在这项横断面研究中，使用了2013 - 2020年美国国家健康和营养检查调查（NHANES）的数据，这是一项评估美国健康和营养状况的全国代表性调查。
纳入年龄在18 - 45岁的女性参与者（n = 6502），其不孕状况通过对生殖健康问题的自我报告回答来确定。主要结局是不孕症，根据过去一年表明受孕困难的回答来定义。连续变量的组间差异通过学生t检验或曼 - 惠特尼U检验分析，分类数据通过卡方检验分析。不孕状况与log UHR之间的独立关联通过log（默认计算自然对数）进行评估。进行亚组分析以评估结果的强度。
不孕组女性的平均log UHR显著高于非不孕组女性（5.34对5.22，P < 0.001）。调整分析显示，log UHR升高与不孕几率增加相关（优势比（OR）= 1.830，95%置信区间（CI）1.396 - 2.401）。亚组分析显示，log UHR升高的35岁以下女性面临更高的不孕风险（OR = 2.716，95% CI 1.784 - 4.162；P < 0.001）。
UHR升高与不孕风险较高相关，这一认识可能有助于制定改善生育结局的非药物干预措施。需要进一步研究以阐明UHR对女性不孕的直接影响，这可为未来的预防和治疗策略提供参考。
