Steatotic liver disease and the risk of fertility-related gynecological disorders in reproductive-aged women: a nationwide cohort study

Abstract Steatotic liver disease (SLD) is a prevalent metabolic disorder associated with various systemic complications. Emerging evidence suggests a link between SLD and women reproductive health, including infertility and gynecological disorders. We aimed to investigate the association between SLD subtypes and the risk of infertility and related gynecological disorders among reproductive-aged women in Korea. This retrospective, population-based cohort study was conducted using data from the Korean National Health Insurance Service. Women of reproductive age were categorized based on the presence or absence of SLD based on the fatty liver index, with SLD further subdivided into metabolic dysfunction-associated, metabolic alcohol-related, and alcohol-related liver disease. Cause-specific hazard ratios for infertility and gynecological disorders were estimated using the Cox's proportional hazard model, adjusting for potential confounders. Among 342,816 participants, the hazard ratios (95% confidence interval) for infertility were estimated at 1.10 (1.04–1.17) for metabolic dysfunction-associated steatotic liver disease, 1.31 (1.17–1.47) for metabolic alcohol-related liver disease, and 1.32 (1.07–1.62) for alcohol-related liver disease. The risks of polycystic ovary syndrome, adenomyosis, and premature ovarian insufficiency were also significantly elevated in patients with SLD subtypes. A clear dose–response trend was observed, with higher alcohol consumption and elevated fatty liver index scores linearly associated with increased disease risk, demonstrating the independent effects of hepatic steatosis and metabolic dysregulation on reproductive-related gynecological disorders. This study illustrates a significant association between SLD and fertility-related gynecological disorders, underscoring the importance of early identification and management in women with SLD who are planning pregnancy.