Association Analysis of Etiological Rules of 283 Cases with Multifactorial Re-fractory Infertility
Objective:To explore the etiological rules of multifactorial refractory infertility patients by association analysis.Methods:A total of 283 patients with refractory infertility met the inclusion criteria from January 2019 to December 2021 in Nanping People's Hospital Affiliated to Fujian University of Traditional Chinese Medicine,were analyzed retrospectively.Using the Apriori algorithm,association rule analysis was performed on 7 etiological fac-tors:fallopian tube obstruction(FTO),intrauterine adhesions(IUA),ovarian dysfunction[diminished ovarian re-serve(DOR),premature ovarian insufficiency(POI)],polycystic ovary syndrome(PCOS),endometriosis(EMT),adenomyosis(AM)and thin endometrium(TE).Further stratified analysis was performed to assess the combina-tions of causes based on the severity of 4 major factors(EMT,FTO,IUA and DOR/POI).Results:①Among 283 patients,EMT(59.0%)and FTO(50.5%)were identified as the most frequent etiological factors,significantly more prevalent than the other causes(P=0.0000,P＜α').②The 5 most common etiological combinations were:FTO with EMT,PCOS with EMT,AM with FTO,DOR/POI with EMT,and AM with EMT.③After stratified analysis,it was found that the following combination of causes was ranked in the top three:with EMT stages I-IV being highly associated with FTO;the degree of merger between low stage with PCOS is high,while the degree of merger be-tween high stage with AM and DOR/POI is high.Different degrees of IUA are highly associated with EMT,FTO and DOR/POI,while severe IUA also being highly associated with TE.Both unilateral and bilateral FTO have a high degree of merger with EMT and AM.DOR and POI have a high degree of merger with EMT,FTO and AM.Conclusions:EMT and FTO are the main causes of refractory infertility.There are correlations among the causes combinations.The etiological factors combined with different stages of endometriosis are also different.These findings underscore the importance of a comprehensive diagnostic framework to address multifactorial etiologies and reduce missed diagnoses.
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