P45 - Evaluating non-insulin-based metabolic markers for infertility risk assessment in women of reproductive age

Background/Introduction Insulin resistance (IR) is linked to a multitude of pathophysiologic processes, resulting in many disorders, one of which is female infertility, a growing global health concern. IR has a detrimental impact on ovulation, oocyte and embryo quality, and endometrial receptivity. Since the limited clinical applicability of insulin-based markers such as HOMA-IR, several non-insulin-based indices have been suggested recently as valuable tools for estimating infertility risk. These include composite metabolic scores like the Metabolic Score for Insulin Resistance (METS- IR), Triglyceride-Glucose-Body-Mass Index (TyG-BMI), TyG–Waist Circumference (TyG-WC), and TyG-Waist-to-Height Ratio (TyG-WHtR) and visceral adiposity- based indices like the Metabolic Score for Visceral Fat (METS-VF), Lipid Accumulation Product (LAP), and Visceral Adiposity Index (VAI), which reflect adipose tissue–related insulin resistance. Purpose To contrast the association and predictive value of non-insulin-based IR markers—metabolic and adiposity-derived indices—with female infertility. Methods A PubMed search using the terms "biomarkers," "female infertility risk," and "insulin resistance" was conducted. Articles published from 2020 to 2025 were screened, and evidence pertinent to qualitative synthesis was extracted. Results Three studies were ultimately included in the qualitative synthesis. Yan et al. (2025) reported that METS-IR was most predictive (AUC = 0.619), with 4.48-fold increased odds of infertility in women in the highest quartile. TyG-BMI, TyG-WHtR, and TyG- WC were also significantly related (ORs = 4.31, 4.65, and 3.86), while HOMA-IR and TyG were not. In addition, Xia et al. (2023) confirmed the independent relation of TyG-BMI (OR = 3.02; AUC = 0.68). Deng et al. (2024) also demonstrated that visceral adiposity–based indices—such as METS-VF (AUC = 0.609), LAP (AUC = 0.590), and VAI (AUC = 0.574)—were associated with infertility, with METS-VF showing the highest predictive value, though differences between markers were not statistically significant (P > 0.05). This highlights the metabolic impact of central adiposity as a driver of insulin resistance and reproductive dysfunction. Conclusion(s) The non-insulin-based IR indices, especially METS-IR and TyG-BMI, show great promise as predictors of infertility. Visceral adiposity markers like METS- VF also indicate the role of fat distribution in IR-related reproductive compromise. These markers offer practical application in early metabolic screening and prevention of infertility in reproductive-age women.