The Establishment And Application Of Nomogram Scoring System For IVF-ET Treatment Outcome In Infertile Women

Objective: The etiology of infertility patients is complicated,and sometimes the etiology is a combination of multiple factors.The outcome of IVF-ET treatment is also affected by many factors.The aim of this study was to investigate the factors that affect the success of IVF-ET.Develop prediction model and Nomogram scoring system to predict the probability of cumulative pregnancy,miscarriage and cumulative birth for an individual patient.Validating the Nomogram scoring system through internal datasets and external dataset.Evaluating the clinical value of the Nomogram scoring system to verify whether Nomogram scoring system is suitable for clinical practice.Provide data support for clinicians to make treatment plans,and patients can also make more reasonable decisions based on the individual probability of success.Methods:(1)Analyze the basic demographic characteristics and clinical indicators of cycle treatment of patients who received IVF-ET treatment from January 1,2013 to December 31,2014 in the Reproductive Medicine Center,the First Affiliated Hospital of Xinjiang Medical University.Patients who received IVF-ET treatment were followed up at least 2years,and investigate the factors of treatment outcome;(2)Select the factors of treatment outcomes through Logistic regression analysis,restricted cubic spline function method,combined with clinical expert recommendations.Develop predictive model of cumulative pregnancy,miscarriage and cumulative delivery,and establish the predictive model to Nomogram scoring system.External validate(temporal validation)these Nomogram scoring systems by applying patient who met the inclusion and exclusion criteria from January 1,2015 to December 31,2017.Evaluating discrimination,calibration and clinical usefulness of these Nomogram scoring system.Results:(1)A total of 2312 cycles of patients met the inclusion criteria and were included in the study.The mean age of women was 33.40±4.82 years,the mean age of men was 35.59±5.34 years,the infertility period was 4.66±3.51 years,the cumulative pregnancy rate was 49.74%,and the ectopic pregnancy rate 2.0%,miscarriage rate of 14.17%,cumulative delivery rate of 41.91%;(2)Predictive factors for predicting the cumulative pregnancy probability Nomogram scoring system were confirmed through literature review,combining the results of statistical analysis and the recommendations of clinical experts,the female age(OR: 0.891,95% CI: 0.871-0.911),the number of oocytes retrieved(OR: 1.074,95% CI: 1.059-1.090),antral follicle count(OR: 1.095,95% CI: 1.073-1.117),endometrial thickness on the day of embryo transfer(OR: 1.120,95% CI: 1.063-1.180),follicle stimulating hormone(OR: 0.914,95% CI: 0.884-0.945);Cumulative pregnancy rate decreases with the increasing female age and follicle stimulating hormone,and increases with the increasing number of oocytes retrieved,antral follicle count,and endometrial thickness on the day of embryo transfer.The C-indexes of the training dataset,the internal validation dataset,and the external validation data set are: 0.693,0.689,and 0.710 respectively,indicating that the Nomogram scoring system has good discrimination,and the calibration curve plot shows that the Nomogram scoring system was well calibrated.DCA shows that the Nomogram scoring system has clinical application value.The predictors for predicting the probability of miscarriage Nomogram scoring system include female age(OR: 1.029,95% CI: 0.988-1.071),number of oocytes retrieved(OR: 0.999,95% CI: 0.974-1.024),endometrial thickness on the day of embryo transfer(OR: 0.967,95% CI: 0.872-1.072),BMI(OR: 1.033,95% CI: 0.972-1.098),previous history of spontaneous miscarriage(OR: 1.326,95% CI: 0.750-2.346),previous history of induced miscarriage(OR: 1.145,95% CI: 0.732-1.793)and previous history of medical miscarriage(OR: 1.301,95% CI: 0.757-2.234).The elder the woman,the lower number of oocytes retrieved and the thinner endometrium thickness were associated with higher trend of miscarriage.Previous history miscarriage was likely related to the occurrence of miscarriage.Obese patients have a high risk of miscarriage.The C-indexes of the training dataset,internal validation dataset,and external validation dataset are: 0.678,0.682,and 0.630,indicating that the Nomogram scoring system has a certain degree of discrimination,and the calibration curve chart shows that the Nomogram scoring system probability measurement result and the actual result was consistent.DCA shows that predicting miscarriage.Nomogram scoring system has clinical application value.(3)The predictor of Nomogram scoring system for predicting the probabilities of cumulative delivery was determined by literature review,combining the results of statistical analysis and the recommendations of clinical experts,including the female age(OR: 0.878,95% CI: 0.857-0.898)and the number of oocytes retrieved(OR: 1.073,95% CI: 1.058-1.089),antral follicle count(OR=1.090,95% CI: 1.069-1.111),endometrial thickness on the day of embryo transfer(OR: 1.124,95% CI: 1.067-1.185),and BMI(OR: 0.978,95% CI: 0.947-1.010).The C-index of the training dataset,the internal validation dataset and the external validation dataset are: 0.705,0.711,and 0.703,respectively.Suggesting that the predictive cumulative delivery Nomogram scoring system has good discrimination ability,and the calibration curve chart shows the Nomogram scoring system had good calibration.DCA showed that the Nomogram scoring system of cumulative delivery has clinical application value.Conclusions: Factors affecting the success of IVF-ET treatment in infertility patients are female age,BMI level,basal endocrine level,number of oocytes retrieved,antral follicle count,and endometrial thickness on the day of embryo transfer.As the age increases,the patient's cumulative pregnancy rate and cumulative delivery rate was reduced,and risk of miscarriage increased.Obese women are at higher risk of miscarriage.Through internal and external validation of cumulative pregnancy,miscarriage and cumulative delivery Nomogram scoring systems,indicating that all the Nomogram scoring systems have clinical value for predicting individual treatment outcomes.