Predictive value of hematological parameters for IVF success: a retrospective analysis

To evaluate the predictive value of hematologic inflammatory indices derived from complete blood count (CBC) parameters for in vitro fertilization (IVF) outcomes in women with unexplained infertility, and to determine their potential role as biomarkers of subclinical inflammation affecting reproductive success.

This retrospective cohort study included 430 women with unexplained infertility who underwent IVF/ICSI cycles at Ege University Hospital between January 2020 and January 2025. CBC parameters and derived systemic inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV)-were measured on the ovulation trigger day. Patients were divided into pregnant and non-pregnant groups according to clinical pregnancy outcomes. Demographic, hormonal, hematologic, and embryologic variables were compared using appropriate statistical tests, and logistic regression and ROC analyses were performed to identify independent predictors of pregnancy.

None of the CBC-derived inflammatory indices showed significant differences between pregnant and non-pregnant groups (all p > 0.05). ROC analysis revealed poor discriminative ability for predicting pregnancy (AUC values 0.48-0.52). In contrast, embryologic variables-particularly the number of two-pronuclei (2PN) embryos and total embryos-were independent predictors of clinical pregnancy (p < 0.05), while excessive oocyte yield was inversely associated with pregnancy (p = 0.028).

Systemic inflammatory indices derived from CBC parameters, including NLR, PLR, MLR, SII, SIRI, and PIV, do not predict IVF/ICSI outcomes in women with unexplained infertility. Embryologic parameters, especially 2PN and total embryo counts, remain the most reliable predictors of clinical pregnancy.