Neutrophil-to-lymphocyte ratio is a predictor of biochemical miscarriage following artificial frozen embryo transfer cycles.

The aim of this study is to examine the relationship between complete blood count (CBC) inflammatory markers and pregnancy outcome following artificial frozen embryo transfer cycles (AC-FET). This was a retrospective cohort study including 183 patients undergoing an AC-FET. The inflammatory markers including white blood cell count (WCC), neutrophil and lymphocyte count, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were compared between cycles with and without clinical pregnancies. Furthermore, these markers were compared between pregnancies with and without biochemical and clinical miscarriages. NLR was significantly higher in cycles with biochemical miscarriages ( p  = 0.009). Receiver operating curve analysis was performed to assess the role of NLR in predicting biochemical pregnancy. The area under the curve was 0.714 (95% confidence interval; 0.578-0.850, p  = 0.009). The optimal cut-off value for NLR that was associated with biochemical miscarriage was 2.48 with 63% sensitivity and 75% specificity. A logistic regression analysis was performed with biochemical miscarriage as the dependent variable. An NLR value below 2.48 was an independent variable to affect biochemical miscarriage (OR: 0.2, 95% CI 0.05-0.92, p  = 0.030). NLR emerged as a reliable predictor of biochemical miscarriage in AC-FET.Impact Statement What is already known on this subject? NLR and PLR are novel markers of inflammation. They are related to various gynecological and obstetric conditions including spontaneous abortion, preeclampsia. These markers are also associated with assisted reproductive technology success in fresh cycles. What the results of this study add? This is the first study to investigate the association of these markers with FET cycles. Our results have shown that cycles that ended in biochemical miscarriage had a significantly higher NLR compared with cycles continuing as a clinical pregnancy. An NLR value above 2.48 was predictive of biochemical miscarriage following AC-FET. What the implications are of these findings for clinical practice and/or further research? A high NLR level might have a significant value for the identification of patients at risk of biochemical miscarriage. Future research should assess the impact of anti-inflammatory agents on pregnancy outcomes in patient populations where systemic inflammation is documented by CBC inflammatory markers.