Systemic inflammatory markers and clinical pregnancy outcomes following first intrauterine insemination in women with polycystic ovary syndrome

Aims: Systemic inflammation is characteristic of polycystic ovary syndrome (PCOS), but its prognostic value for intrauterine insemination (IUI) outcomes remains unclear.We evaluated whether systemic inflammatory markers and metabolic parameters were associated with clinical pregnancy after the first IUI cycle following ovulation induction. Methods:This retrospective cohort study included infertile women with PCOS undergoing their first IUI cycle after ovulation induction with an aromatase inhibitor between May 2021 and May 2026.Clinical pregnancy was defined as ultrasonographic visualization of a gestational sac with fetal cardiac activity.Demographic, clinical, hormonal, metabolic, and IUI cycle characteristics and systemic inflammatory markers-neutrophil-tolymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and C-reactive protein (CRP)-were compared according to pregnancy status.Analyses were performed using Jamovi (version 2.6.45; the Jamovi project, Sydney, Australia).Results: A total of 113 women with PCOS were included [median age: 28 years (interquartile range): 6)]; 31 (27.4%)achieved clinical pregnancy.Demographic, clinical, hormonal, metabolic, and IUI cycle characteristics did not differ between groups (all p>0.05).Likewise, NLR (1.89 vs. 2.12, p=0.333),PLR (124 vs. 123, p=0.716),LMR (5.39 vs. 5.12, p=0.485),SII (519 vs. 591, p=0.533),SIRI (0.85 vs. 1.05, p=0.219), and CRP (2.80 vs. 4.02 mg/L, p=0.191) were similar.CRP correlated positively with body mass index (BMI) (r=0.558,p<0.001).After adjustment for age, BMI, and anti-Müllerian hormone, no inflammatory marker independently predicted clinical pregnancy; CRP showed the strongest but non-significant association (adjusted odds ratio: 1.10, 95% confidence interval: 0.97-1.24,p=0.138). Conclusions:The evaluated systemic inflammatory markers did not demonstrate clear utility in predicting clinical pregnancy during the first IUI cycle in women with PCOS.Larger prospective studies integrating systemic and local endometrial biomarkers may help clarify the potential role of inflammatory pathways in implantation and IUI outcomes.