Li Bianfang, Zhai Han
Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, 712046, P.R. China.
Sixth Department of Obstetrics (Foetal Protection Centre), Northwest Womens and Childrens Hospital, Xi An, China.
Sci Rep. 2025 Apr 28;15(1):14918. doi: 10.1038/s41598-025-99023-7.
Cardiovascular health (CVH) and depression may be associated with female infertility. More recently, it has been suggested that the addition of psychological health assessment to Life's Essential 8 (LE8), known as Life's Crucial 9 (LC9), may be clinically relevant. We aimed to explore the association of LC9 with female infertility and whether LC9 has significantly improved predictive ability for infertility compared to LE8 through NHANES 2013-2018. The LE8 was assessed by the approach proposed by the American Heart Association and included 8 CVH components. LC9 added an additional assessment of depression score based on the Patient Health Questionnaire-9 to LE8. Female infertility was diagnosed by self-report. Multivariate logistic regression analyses were used to explore these associations and to calculate odds ratios (ORs) and 95% confidence intervals (CIs). A total of 2088 women of reproductive age were included in the study, with an infertility prevalence of 13.98%.In the fully adjusted model, higher LC9 scores were associated with reduced odds of female infertility. Women in the highest LC9 quartile (Q2, Q3, and Q4) had consistently lower odds of infertility compared to those in the lowest quartile (Q1), with a significant linear trend observed. The components of LC9 that were found to be inversely associated with infertility included sleep health, body mass index, blood glucose, and depression.The relationship between LC9 and infertility was modified by both age and race/ethnicity. However, LC9 did not demonstrate a significant improvement in its predictive value for infertility when compared to LE8.This study indicate that LC9 is associated with a decreased likelihood of female infertility, suggesting its potential as a comprehensive cardiovascular health metric in this context. However, the study also found that LC9 did not significantly enhance the predictive ability for female infertility when compared to the established LE8 framework. These findings suggest that the inclusion of depression assessment in LE8 may not be essential for the prediction and prevention of female infertility, despite the observed association between depression and infertility. This underscores the need for further research to refine the integration of psychological health into cardiovascular health metrics and to explore targeted interventions for improving reproductive outcomes.
心血管健康（CVH）与抑郁症可能与女性不孕症有关。最近，有人提出在“生命基本八项”（LE8）中增加心理健康评估，即“生命关键九项”（LC9），这可能具有临床意义。我们旨在通过2013 - 2018年美国国家健康与营养检查调查（NHANES）探讨LC9与女性不孕症的关联，以及与LE8相比，LC9对不孕症的预测能力是否有显著提高。LE8采用美国心脏协会提出的方法进行评估，包括8个心血管健康组成部分。LC9在LE8的基础上增加了基于患者健康问卷 - 9的抑郁评分额外评估。女性不孕症通过自我报告进行诊断。采用多变量逻辑回归分析来探讨这些关联，并计算比值比（OR）和95%置信区间（CI）。本研究共纳入2088名育龄女性，不孕症患病率为13.98%。在完全调整模型中，较高的LC9评分与女性不孕症几率降低相关。与最低四分位数（Q1）的女性相比，处于最高LC9四分位数（Q2、Q3和Q4）的女性不孕症几率始终较低，观察到显著的线性趋势。发现与不孕症呈负相关的LC9组成部分包括睡眠健康、体重指数、血糖和抑郁。LC9与不孕症之间的关系因年龄和种族/族裔而有所改变。然而，与LE8相比，LC9对不孕症的预测价值并未显示出显著提高。本研究表明，LC9与女性不孕症可能性降低有关，表明其在这方面作为综合心血管健康指标的潜力。然而，研究还发现，与既定的LE8框架相比，LC9对女性不孕症的预测能力并未显著增强。这些发现表明，尽管观察到抑郁症与不孕症之间存在关联，但在LE8中纳入抑郁评估对于预测和预防女性不孕症可能并非必不可少。这凸显了进一步研究的必要性，以完善将心理健康纳入心血管健康指标的整合，并探索改善生殖结局的针对性干预措施。
