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Background <p>Inflammation and high-density lipoprotein (HDL) metabolism are strongly linked to female infertility. The ratios of neutrophil-, lymphocyte-, platelet- and monocyte-to-HDL cholesterol (NHR, LHR, PHR, and MHR) are HDL-related inflammation indices, which are widely used to indicate the risk of various diseases. However, whether female infertility is associated with these indices remains unexplored. The present study aimed to assess the associations between female infertility and these indices.</p> Methods <p>Datasets were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted from 2013 to 2020. Reproductive status was determined from self-report questionnaire responses. HDL-related inflammation indices were determined by calculating the ratio of different blood cell counts to HDL cholesterol levels. The relationships between these indices and female infertility were evaluated utilizing weighted multivariable logistic regression models, considering both continuous variables and tertile-based groupings. Furthermore, smooth curve fitting was utilized to investigate potential linear relationships, and the results were verified through subgroup analyses and interaction tests.</p> Results <p>A cohort of 3,575 women aged 18–45 years was included, among which 479 individuals (13.4%) were diagnosed with infertility. Infertile participants were significantly older than non-infertile participants (34.50 ± 0.50 versus 31.59 ± 0.19 years, <i>P</i> &lt; 0.0001). When all the covariates were adjusted, there was a notable positive association between Log(MHR) and female infertility (OR = 1.48, 95% CI: 1.02, 2.14, <i>P</i> = 0.04). Compared with women in the first tertile of Log(MHR), women in the second (T2 versus T1: OR = 1.54, 95%CI: 1.11, 2.13) and third (T3 versus T1, OR = 1.49, 95%CI: 1.03, 2.15) tertiles exhibited elevated infertility risks. Additionally, smooth curve fitting revealed a linear relationship between female infertility and Log(MHR). Subgroup analyses confirmed that this association remained consistent across most subgroups.</p> Conclusions <p>There is a modest positive association between Log(MHR) and female infertility. The MHR may be a composite indicator of an underlying inflammatory or metabolic state associated with infertility. Furthermore, the MHR may serve as an auxiliary index for future research exploring the complex interplay between inflammation and female reproductive health.</p>

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Association between high-density lipoprotein-related inflammation index and female infertility in US reproductive-aged women: insights from NHANES 2013–2020

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  • 发表日期：

    2025年11月26日

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  • Jingjing Su,
  • Yuyang Zhang,
  • Xiangxiang Jiang

摘要

Background

Inflammation and high-density lipoprotein (HDL) metabolism are strongly linked to female infertility. The ratios of neutrophil-, lymphocyte-, platelet- and monocyte-to-HDL cholesterol (NHR, LHR, PHR, and MHR) are HDL-related inflammation indices, which are widely used to indicate the risk of various diseases. However, whether female infertility is associated with these indices remains unexplored. The present study aimed to assess the associations between female infertility and these indices.

Methods

Datasets were obtained from the National Health and Nutrition Examination Survey (NHANES) conducted from 2013 to 2020. Reproductive status was determined from self-report questionnaire responses. HDL-related inflammation indices were determined by calculating the ratio of different blood cell counts to HDL cholesterol levels. The relationships between these indices and female infertility were evaluated utilizing weighted multivariable logistic regression models, considering both continuous variables and tertile-based groupings. Furthermore, smooth curve fitting was utilized to investigate potential linear relationships, and the results were verified through subgroup analyses and interaction tests.

Results

A cohort of 3,575 women aged 18–45 years was included, among which 479 individuals (13.4%) were diagnosed with infertility. Infertile participants were significantly older than non-infertile participants (34.50 ± 0.50 versus 31.59 ± 0.19 years, P < 0.0001). When all the covariates were adjusted, there was a notable positive association between Log(MHR) and female infertility (OR = 1.48, 95% CI: 1.02, 2.14, P = 0.04). Compared with women in the first tertile of Log(MHR), women in the second (T2 versus T1: OR = 1.54, 95%CI: 1.11, 2.13) and third (T3 versus T1, OR = 1.49, 95%CI: 1.03, 2.15) tertiles exhibited elevated infertility risks. Additionally, smooth curve fitting revealed a linear relationship between female infertility and Log(MHR). Subgroup analyses confirmed that this association remained consistent across most subgroups.

Conclusions

There is a modest positive association between Log(MHR) and female infertility. The MHR may be a composite indicator of an underlying inflammatory or metabolic state associated with infertility. Furthermore, the MHR may serve as an auxiliary index for future research exploring the complex interplay between inflammation and female reproductive health.