P-416 Low serum ferritin level might be associated with an increased risk of miscarriages in infertility patietns
Authors: Tulenheimo - Silfvast A , Simberg N 
Published: June 2022

Abstract

Study question
Does infertility patients with low serum ferritin have a increased risk of miscarriages and can it be amended by ferric carboxymaltose infusion prior to treatment

Summary answer
The miscarriage rate is higher in patients with low S-Ferrit and can be reduced by correcting the iron deposits with ferric carboxymaltose infusion

What is known already
Iron deficiency is common in fertile age women and seen in around 25 % of women in industrialized countries and up to 50 % in women from developing countries. There are very few studies on the relationship between low iron deposits and infertility. A recent Danish study shows that the lower serum Ferritin levels are, the higher is the risk for repeated miscarriages (Georgsen et al, Fertility & Sterility 2020). A person’s iron deposits are considered empty if S-Ferrit is &lt; 30 ug/l.

Study design, size, duration
We wanted to see how common iron deficiency is in our patient population, defined as S-Ferrit &lt; 30 ug/l, measured in 858 consecutive infertility patients during years 2015-2019. Thereafter the iron deposits were filled in those with low ferritin and a wish for i.v. ferric carboxymaltose infusion. The patients were followed up in a retrospective manner for their reproductive history both before and after the infusion especially regarding the miscarriage rate and live birth rate.

Participants/materials, setting, methods
This is an interim analysis of the first 215 patients with infertility and age younger than 43 years. All patients had a S-Ferrit &lt; 30 ug/l prior to ferric carboxymaltose infusion of 500 mg i.v. The infusions were done from December 2015 to December 2019. Patients with any other indication than history of infertility and S-Ferrit &lt; 30ug/l were excluded from the study. All patients were treated at one private infertility clinic in Helsinki.

Main results and the role of chance
In our 858 patients, the mean S-Ferrit was 41 ug/l and 373 of these patients (43,5 %) had a S-Ferrit &lt; 30 ug/l. In the first 215 patients included in this analysis, who received a ferric carboxymaltose infusion, the mean age was 36,6 years, the mean duration of infertility was 3 years and 5 months, BMI 23,8 and AMH 2,10 ug/l. The cause for infertility was unexplained in 28 %. The mean S-Ferrit was 16,4 ug/l before infusion and 82,4 ug/l on average 3 months after the infusion. Before the infusion, 45,5% of patients had experienced one or more miscarriages, whereas only 20,0% after the infusion (p &lt; 0.001, McNemar’s test). On the contrary, 36,3% of the patients had live birth prior to infusion, and 58,2% after the infusion (p &lt; 0.001). In the group of patients with unexplained infertility, the differences were even greater than in the whole material.

Limitations, reasons for caution
The study is retrospective in nature, where the patient is her own control, before and after infusion. With increasing number of infertility treatments patients tend to use more PGT-A and donor oocytes which might favour the results after infusion.

Wider implications of the findings
The study underlines the importance of measuring the S-Ferritin levels in patients seeking help for their infertility problem. The S-Ferrit measurement should be included in the initial workup of the patients, as it might be one explanation for (unexplained) infertility and miscarriages.

Trial registration number
Findata THL.7013.14.02.00.2020.