<p>Steatotic liver disease (SLD) is a prevalent metabolic disorder associated with various systemic complications. Emerging evidence suggests a link between SLD and women’s 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-associated liver disease. Cause-specific hazard ratios for infertility and gynecological disorders were estimated using the Cox proportional hazards 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-associated liver disease. The risks of polycystic ovary syndrome, adenomyosis, and premature ovarian insufficiency were also significantly elevated in patients with SLD subtypes. A dose–response trend was observed, with higher fatty liver index scores being associated with a progressively higher disease risk. This relationship remained evident after adjustment for alcohol consumption, suggesting an independent link between hepatic steatosis, metabolic dysregulation, and reproductive-related gynecological disorders. In conclusion, this study illustrates a significant association between SLD and fertility-related gynecological disorders, underscoring the potential value of early identification in women with SLD who are contemplating pregnancy.</p>