First trimester neutrophil-to-lymphocyte ratio (NLR) and pregnancy outcomes in medically assisted reproduction (MAR): a case control study

Predicting the Outcomes of In Vitro Fertilization Using Baseline Maternal Serum Inflammatory Markers: A Retrospective Cohort Study

PROBLEM

Achieving pregnancy through in vitro fertilization (IVF) remains a challenge, with less than one-third of women succeeding. There is a pressing need for reliable predictive tools to assess the likelihood of post-IVF pregnancy. While some serum inflammatory biomarkers have been investigated for their predictive potential, substantial knowledge gaps persist. This study examined the utility of different inflammatory markers in predicting IVF outcomes.

METHOD OF STUDY

Inflammatory markers including the white blood cell count, neutrophil-to-lymphocyte ratio (NLR), platelet count, mean platelet volume, platelet distribution width, platelet-to-lymphocyte ratio (PLR), C-reactive protein (CRP), erythrocyte sedimentation rate, and vitamin D3 were assessed. Study outcomes were chemical pregnancy (positive serum beta-human chorionic gonadotropin 2 weeks post-embryo transfer), clinical pregnancy (detection of pregnancy sac via transvaginal ultrasonography), and viable pregnancy (detection of fetal heart rate). Univariate and multivariate logistic regression analyses were conducted, with multivariate analysis incorporating age, body mass index, infertility duration, type, and etiology, as well as all studied serum inflammatory markers, embryo count, stage, quality, and endometrial thickness.

RESULTS

Lower NLR (p < 0.001, odds ratio [OR] = 0.372 [0.247-0.559]) and CRP (p = 0.035, odds ratio = 0.956 [0.916-0.997]) predicted chemical pregnancy in univariate analysis, with NLR maintaining significance in multivariate analysis (p = 0.022, OR = 0.319 [0.120-0.848]). Lower NLR (p < 0.001, OR = 0.309 [0.198-0.482]) and PLR (p = 0.013, OR = 0.994 [0.990-0.999]) predicted clinical pregnancy, with NLR surviving multivariate analysis (p = 0.005, OR = 0.217 [0.075-0.626]). Lower NLR (p < 0.001, OR = 0.320 [0.198-0.516]) also predicted viable pregnancy, maintaining statistical significance in multivariate analysis (p = 0.002, OR = 0.177 [0.058-0.541]). Other studied inflammatory markers did not predict IVF outcomes.

CONCLUSIONS

NLR emerged as a robust independent predictor of pregnancy attainment after IVF.

Could fibrinogen to albumin ratio be a predictive marker for recurrent pregnancy loss

AIMS

Recurrent pregnancy loss (RPL) is usually defined by two or more consecutive clinical miscarriages, which causes psychological trauma for couples. In this study, we aimed to investigate the predictive role of fibrinogen to albumin ratio (FAR) in patients with RPL.

METHODS

Pregnant women in their first trimester of pregnancy were included in the study and divided into two groups as RPL patients (n: 44) and patients with no previous recurrent miscarriage (n: 60) as control group. Demographical parameters and routine blood parameters (fibrinogen, D-dimer, FAR, neutrophil to lymphocyte ratio [NLR], platelet count, main platelet volume [MPV], and red cell distribution width [RDW] values) were compared between the RPL group and the control group.

RESULTS

The groups were determined to be statistically different in regard to gravidity and parity (P < .001). The difference between the groups was statistically different in regard to fibrinogen (mg/dL), albumin (g/dL), FAR (%), NLR (%), RDW-coefficient of variation (%), RDW-standard deviation (fl), and platelet counts (10^-3 /μL). However, MPV (fl) and D-dimer (μg/L) levels were similar in both groups. The receiver operating characteristic curve analysis revealed that the NLR levels were 84.1% sensitive and 75% specific with a cut-off value of 4.27 and the FAR levels were 79.5% sensitive and 88.3% specific with a cut-off value of 105.69 for predicting RPL.

CONCLUSION

Our results indicate that the FAR and NLR levels seem to be effective parameters for predicting RPL with high sensitivity and specificity.