A nomogram prediction model of clinical pregnancy in fresh embryo transfer by the use of GnRH-a long protocol
Objective To discuss the influencing factors of clinical pregnancy outcome in patients undergoing fresh embryo transfer by the use of Gonadotrophin releasing hormone-agonists(GnRH-a)long protocol,construct a prediction model of clinical pregnancy according to those factors,and then verify the model.Methods A total of 4 627 cycles of fresh embryo transfer by the use of GnRH-a long protocol from January 2019 to April 2023 were performed in the Reproductive Medicine Center of the First Hospital of Lanzhou University.After excluding the relevant cycles according to the exclusion criteria,general clinical data and pregnancy outcomes of the included patients were statistically analyzed according to the data type.The least absolute shrinkage and selection operator(LASSO)regression technique and multivariate logistic regression analysis were used to select data dimensions and predictors.The 3 740 cycles included were randomly assigned to the training set(n=2429)and test set(n=1 041)according to the ratio of 7∶3.Multivariate logistic regression analysis was used to establish a predictive model and nomogram for pregnancy outcome of fresh embryo transfer.The model was evaluated by calculating the area under the curve(AUC),Hosmer-Lemeshow test and decision curve analysis(DCA).Results According to the non-zero coefficient calculated by LASSO regression analysis,18 variables were selected for further multivariate logistic regression analysis.Ten factors including female age,family history of hypertension,polycystic ovary syndrome(PCOS),recurrent pregnancy loss(RPL),daily dose of gonadotropin(Gn),trigger protocol,progesterone(P)level on the trigger day,number of embryos transferred,number of high-quality embryos transferred,embryo type(blastocyst or not),endo-metrial thickness on the trigger day and asthenospermia were used as predictors to establish the model,as displayed by the nomogram.The AUC of the training set was 0.657,and the AUC of the validation set was 0.617.The Hosmer-Lemeshow goodness-of-fit test results showed that the model fitted well(Mean absolute error=0.008).DCA suggested that when the threshold probability of clinical pregnancy in patients with fresh embryo transfer was between 15%and 70%,the application of this nomogram could increase the net income.Conclusion This model can provide a reference for the prediction of clinical pregnancy outcomes in fresh embryo transfer by the use of GnRH-a long protocol cycles.However,the prediction accuracy of this study is limited,and more effective prediction models need to be developed in the future.
reproductive techniques,assistedGnRH-a long protocolpregnancy outcomenomogram
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