Decoding the potential association of liver steatosis with female infertility: an analysis from NHANES 2013-2018.

BACKGROUND

Female infertility is a global health issue, with metabolic disorders emerging as significant contributors. Liver steatosis, characterized by excessive hepatic fat accumulation, is closely linked to metabolic dysfunction and may be associated with infertility. However, the relationship between liver steatosis and female infertility remains unclear.

METHODS

This study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2013–2018, including 1,167 women aged 20–44 years. Liver steatosis was assessed using the Fatty Liver Index (FLI), Hepatic Steatosis Index (HSI), and ZJU index. Infertility status was determined based on self-reported pregnancy history. Weighted multivariate logistic regression analysis was performed to evaluate the association between liver steatosis and female infertility. Dose-response relationships between liver steatosis and female infertility were explored using weighted restricted cubic spline analysis. Subgroup analysis further investigates the stability and population differences of these associations. ROC curve demonstrates the predictive ability of hepatic steatosis for female infertility.

RESULTS

Among the participants, 161 women (13.80%) were infertile. Higher values of FLI, HSI and ZJU index were significantly associated with increased prevalence of infertility even after adjusting for multiple covariates. The dose-response relationship was linear for all indices. Subgroup analyses revealed significant interactions in different age, race, marital status and physical activity groups. ROC curve analysis showed no significant difference in the predictive ability of the three indices for infertility.

CONCLUSIONS

This study highlights the significant association between hepatic steatosis and female infertility. However, the FLI, HSI and ZJU index, as independent screening tools for female infertility, have limited roles in clinical applications. Given the limitations of cross-sectional design, further longitudinal studies or intervention studies are needed in the future to explore the causal relationship between hepatic steatosis and female infertility.