Context: Premature ovarian insufficiency (POI) etiology may be related to endogenous factors and in many cases remains unclear. Vitamin A (VA) and its derivatives are required for maintaining reproduction, embryogenesis, and normal cell proliferation and differentiation. Objective: To explore the correlation between serum VA level and in POI women of reproductive age. Methods: In this case-control study, 47 women with premature ovarian insufficiency and 67 control subjects matched in age and body mass index (BMI) in the Women’s Hospital, School of Medicine, Zhejiang University was enrolled. Clinical and demographic data along with laboratory findings from the participants and the hospital database were retrieved after having obtained a written informed consent from all the participants. Patients: Women of reproductive age with POI. Interventions: Standard POI evaluation. Main Outcome Measure: Age, body mass index, smoking, family history, comorbidities, complete blood count, baseline hormone levels, vitamin A, anti-Müllerian hormone (AMH), serum total cholesterol. Results: The serum level of vitamin A and total cholesterol in the women with POI were significantly higher compared to the other group(728±26 μg/L vs 662±14 μg/L，5.20±0.16 mmol/L vs 4.31±0.09mmol/L, p < 0.05, respectively)，in univariable analysis. However，Serum vitamin A /total cholesterol ratio（VA/TC）was lower in the POI group (143.14±5.23 μg/ mmol vs 157.56±4.30 μg/ mmol, p < 0.05). VA/TC showed a negative correlation with serum FSH (r=-0.194, p < 0.05), serum LH(r=-0.218，p < 0.05) of POI patients but not with other measured clinical and biochemical variables. A final logistic regression analysis demonstrated that serum level of vitamin A is independently associated with POI. Conclusions: Women in reproductive age with POI have significantly increased the level of serum VA and decreased VA/TC compared with healthy women in reproductive age. The serum vitamin A level was associated with POI, and its internal mechanism may be related to lipid REDOX reaction. Serum VA level and VA/TC can be used as an important marker for POI, which have potential application value in POI prevention and clinical treatment.