Baseline neutrophil-to-lymphocyte ratio and cumulative clinical pregnancy and obstetric/neonatal outcomes after IVF/ICSI in women with PCOS: exploratory analysis including sperm preservation method.
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BACKGROUND: In women with polycystic ovary syndrome (PCOS), IVF/ICSI outcomes may be influenced by systemic inflammation (neutrophil-to-lymphocyte ratio, NLR) and by sperm preservation method. METHODS: We retrospectively studied 276 first eligible autologous PCOS IVF/ICSI cycles. NLR was dichotomized at 2.6 (low n = 136; high n = 140), whereas adjusted models used continuous NLR after exploratory spline assessment showed no convincing nonlinearity. Clinical pregnancy was defined cumulatively from the index retrieval cycle, including fresh or frozen transfer(s) derived from that cycle. Male-factor/semen characteristics were summarized by sperm method. Multivariable logistic regression evaluated cumulative clinical pregnancy in all cycles and an exploratory composite adverse pregnancy/neonatal outcome among 144 clinical pregnancies. Sensitivity analyses repeated the adjusted models using the dichotomized high-versus-low NLR grouping. RESULTS: Cumulative clinical pregnancy was lower with high versus low NLR (42.9% vs 61.8%; p = 0.002). Among clinical pregnancies, the exploratory composite adverse outcome was more frequent with high versus low NLR (58.3% vs 27.4%; p < 0.001). In adjusted analyses, each 1-unit increase in NLR was associated with lower odds of cumulative clinical pregnancy (aOR 0.71, 95% CI 0.53-0.95; p = 0.023) and higher odds of the exploratory composite adverse outcome (aOR 2.32, 95% CI 1.44-3.74; p < 0.001). Sensitivity models using dichotomized NLR were directionally consistent for cumulative clinical pregnancy (high vs low NLR: aOR 0.52, 95% CI 0.31-0.86; p = 0.011). Sperm preservation method was not independently associated with either outcome, and NLR × sperm interaction terms were not significant. Exploratory ROC analysis for the pregnancy cohort showed modest discrimination (AUC 0.67, 95% bootstrap CI 0.57-0.76); the Youden-derived cutoff of 3.16 yielded sensitivity 53.4% and specificity 84.9%. CONCLUSIONS: Higher baseline NLR was associated with lower cumulative clinical pregnancy and higher subsequent obstetric/neonatal risk in PCOS IVF/ICSI cycles. After accounting for baseline covariates and male-factor differences, fresh versus frozen ejaculated sperm was not independently associated with either outcome in this analysis. The ROC-derived cutoff should be viewed as exploratory only.