Association between different atherogenic and insulin resistance indices and infertility in polycystic ovary syndrome patients

Abstract

Background This study aimed to assess the association between multiple atherogenic and insulin resistance indices—including TyG, TyG-BMI, AIP, TG-HDL, and METS-IR—and infertility in women with PCOS, and to evaluate their clinical utility. Methods In this cross-sectional study, we analyzed data from 669 sexually active women aged 18–45 with PCOS treated at a tertiary center in Iran (2021–2023). We compared infertile women with PCOS (≥12 months unsuccessful conception, n = 274) to fertile women with PCOS (n = 395). Logistic regression, restricted cubic spline, and receiver operating characteristic (ROC) analysis were used to assess associations and predictive performance. Results Infertile women had significantly worse metabolic profiles across all indices (P < 0.001). AIP showed the largest point estimate of association (adjusted OR = 9.065, 95% CI: 1.722–47.721). TG-HDL showed a significant non-linear relationship, with ORs rising steeply up to a ratio of ~2.5. Predictive ability was modest, with AUCs ranging from 0.598 (TyG-BMI) to 0.625 (AIP, TG-HDL). Conclusion Several metabolic indices, particularly AIP, are associated with infertility in women with PCOS, though their standalone predictive utility remains limited.