Ling Tian,1,* Xiangzhi Qin,2,* Mingtao Yang,1 Wen Tang,1 Lu Feng,1 Junrong Huang,1 Huiquan Hu1 

1Department of Gynaecology, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, People’s Republic of China; 2Department of Gastrointestinal Hernia Surgery, Beijing Anzhen Nanchong Hospital, Capital Medical University & Nanchong Central Hospital, Nanchong, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Huiquan Hu, Email 36311773@qq.com

Background: The ZJU index is a composite metabolic score that integrates blood glucose, body mass index (BMI), liver enzyme ratios (ALT/AST), and triglyceride levels, originally developed to predict non-alcoholic fatty liver disease. However, its relationship with infertility remains unclear. This study aims to examine the association between the ZJU index and infertility in reproductive-aged women.
Methods: We conducted a cross-sectional study using data from the 2013– 2018 National Health and Nutrition Examination Survey (NHANES). Multivariable logistic regression models were applied to evaluate the relationship between the ZJU index and infertility. Restricted cubic spline (RCS) regression was also used to explore potential non-linear associations. Subgroup analyses were conducted based on sociodemographic and metabolic factors to evaluate the stability of the results.
Results: A total of 1,538 reproductive-aged women (18– 45 years) were included in the analysis. Multivariable regression analysis revealed a significant positive association between the ZJU index and infertility (OR = 1.04, 95% CI: 1.00– 1.07, P< 0.05). RCS analysis confirmed a linear relationship between the ZJU index and infertility risk (P for nonlinear = 0.755). Moreover, the association remained robust across various subgroups.
Conclusion: The ZJU index significantly associated with the prevalence of infertility emphatically related with the predominance of infertility among reproductive-aged women within the United States. These discoveries recommend that the ZJU index may serve as a profitable biomarker for evaluating infertility hazard.

Keywords: ZJU index, infertility, insulin resistance, obesity, NHANES