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C-reactive protein levels predicted future risk for stroke, MI following IVF
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American Society for Reproductive Medicine 65th Annual Meeting
Elevated C-reactive protein levels predicted risk for stroke and myocardial infarction in a group of women with low incidence for polycystic ovary syndrome undergoing in vitro fertilization, according to data presented here.
In the retrospective case-control study, researchers from New York University Langone Medical Center analyzed C-reactive protein levels from 171 women. One group contained 75 women who did not start IVF because of follicle-stimulating hormone levels <13.4 mIU/mL, and the control group included 96 age-matched controls who had 10 or more eggs retrieved. Researchers collected measurements using Immulite 2500 immunoassay and a high-sensitivity C-reactive protein kit.
Women with elevated FSH levels on day three had lower mean C-reactive protein levels (1.74; 95% CI, 0.6089 to 2.868) compared with controls (3.70; 95% CI, 2.334 to 5.062).
The primary etiology for infertility among women who had eggs retrieved was tubal, male, unexplained, recurrent pregnancy loss and other, in decreasing order.
Three women in the study had PCOS; none were metabolic.
“Our study demonstrates C-reactive protein levels are lower in women with poor reserve as compared to women with established ovarian reserve, suggesting that the elevated levels of C-reactive protein found in women with PCOS may not be related to vascular inflammation or the metabolic syndrome,” the researchers concluded.
“This sets the stage to further explore the clinical utility of measuring C-reactive protein to predict ovarian reserve and to determine an etiology for the relationship between elevated C-reactive protein levels, lower FSH levels and sufficient ovarian function.” - by Jennifer Southall
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The authors report an interesting finding that seems to fly in the face of their expectations that women with elevated FSH and low ovarian reserve would have elevated hs-CRP levels. There has long been an association noted between premature ovarian failure and increased cardiovascular disease in women; however, low ovarian reserve, while believed to be a clinical condition that will lead to premature ovarian failure, may be a less severe or even different state and therefore was not found to be linked to elevations in CRP. It would be interesting to know more about the high-CRP group's traditional risk factors for cardiovascular disease, such as high BMI, features of the metabolic syndrome and indices of glucose metabolism, that might account for the elevation of this well established risk factor for subsequent heart disease. This is one of those cases where the research raises new questions that may cause us to reformulate our thinking.
– Nannette Santoro, MD
Director of the division of REI, Albert Einstein College of Medicine, Montefiore Medical Center
