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Low-grade inflammation is negatively associated with live birth in women undergoing IVF

Published:October 16, 2022DOI:https://doi.org/10.1016/j.rbmo.2022.10.004

      Highlights

      • Low-grade inflammation is associated with different medical conditions
      • Low-grade inflammation is negatively associated with chance of live birth
      • There is no association between low-grade inflammation and the chance of conceiving
      • There is an increased risk of pregnancy loss with increasing C-reactive protein concentrations

      Abstract

      Research question

      Is low-grade inflammation, detected by C-reactive protein (CRP), a marker of IVF outcome addressing both blastocyst quality and pregnancy outcome?

      Design

      This sub-study of a multicentre randomized controlled trial included 440 women undergoing IVF treatment with a gonadotrophin-releasing hormone (GnRH) antagonist protocol. Serum CRP was measured on cycle day 2–3 (baseline) and on the day of ovulation triggering. The association between CRP concentrations and reproductive outcomes (number of retrieved oocytes, number of good-quality blastocysts, pregnancy, pregnancy loss and live birth), were analysed, adjusting for relevant confounders.

      Results

      A negative association was found between higher baseline CRP concentrations and live birth rate (odds ratio [OR] 0.77, 95% confidence interval [CI] 0.62–0.96, P = 0.02) and higher CRP concentrations at baseline were associated with pregnancy loss among women who conceived (OR 1.37, 95% CI 1.07–1.76, P = 0.01). When testing for a specific cut-off, CRP concentrations above 2.34 (the highest quartile) were more likely to be associated with pregnancy loss (P = 0.02) and a lower chance of live birth (P = 0.04) compared with the lowest quartile. No associations were found between CRP concentrations and pregnancy outcomes on the day of ovulation triggering, and there were no associations between CRP concentrations and the number of good-quality blastocysts.

      Conclusions

      Higher CRP concentrations at cycle day 2–3, before starting ovarian stimulation, are negatively associated with chance of live birth, possibly because of an increased risk of pregnancy loss. No association was found between the number of good-quality blastocysts and CRP concentration. More studies are needed to investigate the impact of low-grade inflammation.

      Keywords

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      Biography

      Laura Emilie Vexø, MD, graduated from the University of Copenhagen in 2020. In 2019 she had a research scholarship and participated in the initiation of a larger study about the microbiome and endometriosis. Laura is currently working as an MD at the Department of Obstetrics and Gynaecology, Copenhagen University Hospital Hvidovre, Denmark.
      Key Message
      Higher C-reactive protein (CRP) concentrations at baseline are associated with a lower chance of live birth and increased risk of pregnancy loss. If confirmed, CRP could be used as a biomarker guiding IVF treatment. Future studies should evaluate the efficacy of using anti-inflammatory drugs to lower CRP concentrations to prevent pregnancy loss.