Usefulness of a combined NLR - CA-125 marker (NLR x CA-125) in the prediction of OHSS in IVF / ICSI patients

Recently, Cho et al. (1) described the validity of the combination of the
neutrohpil/lymphocyte ratio (NLR) and the serum CA-125 concentration as a
diagnostic marker for endometriosis and ovarian tumors, both malignant and
benign. In patients with a benign ovarian tumor a significantly higher NLR was
found, compared with controls (2.31 versus 1.99).
During IVF / ICSI, serum CA-125 concentations rise and higher CA-125 levels are
related to higher clinical pregnancy rates (2).
Ovarian hyperstimulation syndrome (OHSS) is a serious and relatively common
complication of IVF/ICSI. Early detection of OHSS after IVF/ICSI is essential
for the wellbeing of the patient and for the chances of a successful pregnancy.
Both NLR and CA-125 are increased in IVF/ICSI patients with and without OHSS.
However, NLR and CA-125 levels are substantially higher in OHSS patients
compared with IVF/ICSI patients without OHSS (pilot study Sint Franciscus
Gasthuis). Determination of the combined NLR and CA-125 concentration might
predict OHSS. Especially differences in the early phase of the IVF/ICSI
treatment could have clinical value. Therefore, NLR and CA-125 concentrations
are measured at the time of oocyte pickup (OPU) and in the midluteal phase.


1) Cho, S., Cho, H., Nam, A., Kim, H.Y., Choi, Y.S., Park, K.H., Cho, D.J. and
Lee, B.S. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the
diagnosis of endometriosis. Fertility and Sterility 2009; 90: 2073-2079.

2) Baalbergen A, Janssen JW, van der Weiden RMF. CA-125 levels are related to
the likelihood of pregnancy after in vitro fertilization and embryo transfer.
Am J Reprod Immunol 2000; 43: 21-24.








A recent study showed that the neutrophil/lymfocyt ratio (NLR) combined with
the CA-125 serum concentration is a diagnostic marker for endometriosis. This
study also showed that patients with a benign ovarian tumor had significantly
elevated NLR (2.31) compared with healthy controls (1.99). To study the
prognostic value of the CA-125 serum concentration combined with the NLR in the
chance to get pregnant, we must study the NLR in patients with OHSS first.
Because it is already known from recent studies that the NLR is significantly
higher in patients with a benign ovarian tumor, as well as the CA-125 serum
concentration (1).

1) Cho, S., Cho, H., Nam, A., Kim, H.Y., Choi, Y.S., Park, K.H., Cho, D.J. and
Lee, B.S. Neutrophil-to-lymphocyte ratio as an adjunct to CA-125 for the
diagnosis of endometriosis. Fertility and Sterility, Vol. 90, No. 6, December
2008.

To determine the usefulness of a combined NLR - CA-125 marker (NLR x CA-125) in
the prediction of OHSS in IVF/ICSI patients.

Venous serum samples are taken during IVF/ICSI treatment:

1) after insertion of the intravenous line for analgesia prior to OPU (no extra
venapuncture).

2) in the midluteal phase (one week after OPU).

Laboratory tests:
- CA-125
- Leucocyte differentiation (NLR)
- CRP
- Ht
- Estradiol

Serum amples are stored at - 70 Celsius.

Risk associated with an extra venapuncture.