Association Between the HbA1c-To-HDL-C Ratio and Female Infertility Among Reproductive-Aged Women: Evidence from NHANES.
- 1Department of Emergency Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, People's Republic of China.
- 2Department of Rheumatology and Immunology, Linquan County People's Hospital, Fuyang, Anhui Province, People's Republic of China.
- 3Department of Cardiovascular Medicine, Linquan County People's Hospital, Fuyang, Anhui Province, People's Republic of China.
Abstract
Metabolic abnormalities have been increasingly implicated in female reproductive dysfunction. The HbA1c-to-HDL-C ratio may reflect the combined burden of chronic glycemic exposure and lipid-related metabolic status; however, its relationship with female infertility remains insufficiently understood. This study investigated the association between the logarithmically transformed HbA1c-to-HDL-C ratio [Log (HbA1c/HDL-C)] and infertility among reproductive-aged women. This cross-sectional study included women aged 18-45 years from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2018. After applying the exclusion criteria, 2452 participants were included, comprising 329 women with infertility and 2123 without infertility. Log (HbA1c/HDL-C) was analyzed as both a continuous variable and quartiles. Weighted multivariable logistic regression models were used to estimate the association between Log (HbA1c/HDL-C) and infertility. Restricted cubic spline analysis was performed to evaluate the dose-response pattern, and subgroup analyses were conducted to assess potential heterogeneity across population characteristics. Compared with women without infertility, those with infertility were older and had higher BMI, HbA1c, and Log (HbA1c/HDL-C) levels. In the primary multivariable model, higher Log (HbA1c/HDL-C) was associated with greater odds of infertility (OR = 1.93, 95% CI: 1.03-3.60). Women in the highest quartile had higher odds of infertility than those in the lowest quartile (OR = 1.90, 95% CI: 1.13-3.22), with a significant trend across quartiles. The association was more apparent among women younger than 35 years. After additional adjustment for BMI, the association was attenuated (OR = 1.64, 95% CI: 0.85-3.16). Higher Log (HbA1c/HDL-C) was associated with greater odds of self-reported female infertility in models without BMI, but the association was attenuated after BMI adjustment. These findings suggest that adiposity may partly account for the observed relationship and require confirmation in prospective studies.
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BibTeX
@article{wang2026association,
title = {{Association Between the HbA1c-To-HDL-C Ratio and Female Infertility Among Reproductive-Aged Women: Evidence from NHANES.}},
author = {Xiaoxue Wang and Shuilin Luo and Hao Cheng},
journal = {International journal of women's health},
year = {2026},
month = nov,
doi = {10.2147/ijwh.s627767},
url = {https://europepmc.org/article/MED/42999843},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - Association Between the HbA1c-To-HDL-C Ratio and Female Infertility Among Reproductive-Aged Women: Evidence from NHANES.
AU - Xiaoxue Wang
AU - Shuilin Luo
AU - Hao Cheng
PY - 2026
DA - 2026/11/03
JO - International journal of women's health
DO - 10.2147/ijwh.s627767
UR - https://europepmc.org/article/MED/42999843
AB - Metabolic abnormalities have been increasingly implicated in female reproductive dysfunction. The HbA1c-to-HDL-C ratio may reflect the combined burden of chronic glycemic exposure and lipid-related metabolic status; however, its relationship with female infertility remains insufficiently understood. This study investigated the association between the logarithmically transformed HbA1c-to-HDL-C ratio [Log (HbA1c/HDL-C)] and infertility among reproductive-aged women. This cross-sectional study included women aged 18-45 years from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2018. After applying the exclusion criteria, 2452 participants were included, comprising 329 women with infertility and 2123 without infertility. Log (HbA1c/HDL-C) was analyzed as both a continuous variable and quartiles. Weighted multivariable logistic regression models were used to estimate the association between Log (HbA1c/HDL-C) and infertility. Restricted cubic spline analysis was performed to evaluate the dose-response pattern, and subgroup analyses were conducted to assess potential heterogeneity across population characteristics. Compared with women without infertility, those with infertility were older and had higher BMI, HbA1c, and Log (HbA1c/HDL-C) levels. In the primary multivariable model, higher Log (HbA1c/HDL-C) was associated with greater odds of infertility (OR = 1.93, 95% CI: 1.03-3.60). Women in the highest quartile had higher odds of infertility than those in the lowest quartile (OR = 1.90, 95% CI: 1.13-3.22), with a significant trend across quartiles. The association was more apparent among women younger than 35 years. After additional adjustment for BMI, the association was attenuated (OR = 1.64, 95% CI: 0.85-3.16). Higher Log (HbA1c/HDL-C) was associated with greater odds of self-reported female infertility in models without BMI, but the association was attenuated after BMI adjustment. These findings suggest that adiposity may partly account for the observed relationship and require confirmation in prospective studies.
SN - 1179-1411
ER -