Objective To explore the diagnostic value of long non-coding RNA nuclear-enriched abundant transcript 1(LncRNA NEATl)and microRNA(miR)-424-5p in the diagnosis of endometriosis(EM)combined with infertility and its application value in disease staging.Methods A total of 232 EM patients who visited Shijiazhuang Maternal and Child Health Hospital from October 2021 to October 2023 were selected as the study subjects,120 patients with EM combined with infertility were used as the infertility group,and 112 patients with pure EM were regarded as the control group.The infertility group was separated into r-AFS stages Ⅰ～Ⅱ(n=27),r-AFS stage Ⅲ(n=45),and r-AFS stage Ⅳ(n=48)according to the American r-AFS staging standards,and qRT-PCR method was applied to detect the expression levels of serum LncRNA NEAT1 and miR-424-5p.Receiver operating characteristic(ROC)curve was applied to analyze the value of serum LncRNA NEAT1 and miR-424-5p in diagnosing EM combined with infertility,and multivariate Logistic regression was applied to analyze the influencing factors of EM combined with infertility.Bioinformatics analysis of LncRNA NEAT1 targeting miR-424-5p was performed on the TargetScanHuman website.Pearson method was applied to analyze the correlation between serum LncRNA NEAT1 and miR-424-5p expression levels in patients with EM combined with infertility.Results Differences of serum LncRNA NEAT1(1.16±0.15 vs 1.02±0.13),pelvic surgery history ratio(17.50％vs 1.79％),miR-424-5p(0.92±0.11 vs 1.04±0.12)expression levels between infertility group and control group were significant,and the differences were significant(t=7.753,16.018,7.974,all P＜0.05).Serum LncRNA NEAT1(1.05±0.10,1.14±0.14,1.24±0.19)increased and miR-424-5p(0.99±0.12,0.93±0.11,0.87±0.10)decreased in r-AFS stage Ⅰ～Ⅱ,Ⅲ,Ⅳ patients,and the differences were significant(F=13.528,10.910,all P＜0.05).There was a targeting relationship between LncRNA NEAT1 and miR-424-5p,and there was a negative correlation between serum LncRNA NEAT1 and miR-424-5p expression levels in EM patients with infertility(r=-0.431,P＜0.05).The AUCs of serum LncRNANEAT1,miR-424-5p,and combined diagnosis for EM combined with infertility were 0.782,0.719 and 0.835,respectively,and the AUC of combined diagnosis was better than that of individual detection(Z=2.625,3.861,P=0.009,0.001).LncRNA NEAT1 was a risk factor for EM combined with infertility,while miR-424-5p was a protective factor(all P＜0.05).Conclusion The expression level of serum LncRNA NEAT1 is increased and miR-424-5p is decreased in EM patients with infertility,both of which are related to the disease stage and the occurrence of infertility.