Analysis Of Factors Influencing Live Birth Outcome In Frozen-thawed Embryo Transfer Cycle And Construction Of Prediction Model

Part Ⅰ: Analysis of factors influencing live birth outcome in frozen-thawed embryo transfer cycle and construction of prediction modelObjective: To investigate the influencing factors of live birth outcome in patients with frozen-thawed embryo transfer,and to construct a prediction model of live birth based on the independent influencing factors,and to verify the model.Methods: Clinical data were collected from 2212 FET cycles of patients admitted to the Reproductive Center of the First Hospital of Lanzhou University from January2019 to December 2020.The 2212 included cycles were randomly assigned to training set（n=1547）and test set（n=665）in a ratio of 7:3.Univariate logistic regression analysis was used to conduct statistical analysis on the general clinical data and FET main indicators of patients in the training set（n=1547）,to explore the impact of these indicators on live birth.The indicators with differences in the univariate logistic regression analysis were again included in the multivariate logistic regression analysis to determine the independent influencing factors of live birth.Based on the results of the multivariate logistic regression analysis,a live birth nomogram model was constructed,and the model was validated and evaluated with the data from the test set（n=665）.Results: Univariate logistic regression analysis showed that: among patients undergoing FET,male age,female age,indication of assisted pregnancy,endometrial thickness,infertility duration,embryo transfer days were closely related to live birth;Multivariate logistic regression analysis showed that female age,indication of progesterone,infertility duration,days of embryo transfer and endometrial thickness were the independent influencing factors of FET live birth.The area under the curve（AUC）was 0.639（95%CI: 0.597-0.680）for the nomogram model based on the female’s age,indication of pregnancy,infertility duration,days of embryo transfer and endometrial thickness.For external validation,the AUC of the test set was 0.624（95%CI: 0.597-0.652）,indicating that the prediction ability of this model is general and the stability is good.Conclusion: Through univariate and multivariate logistic regression analysis,it was found that the independent influencing factors of live birth in FET patients were:female age,endometrial thickness,indication of assisted pregnancy,infertility duration,and embryo transfer days.In this study,a prediction model of live birth was constructed based on the above factors,and the model was verified externally.Part Ⅱ: Analysis of factors influencing live birth outcome of Gn RH-a hormone replacement therapy in frozen-thawed embryo transfer cycleObjective: To investigate the influencing factors of live birth in first-time FET patients who underwent a Gn RH-a hormone replacement therapy.Methods: Clinical data of 2212 patients undergoing FET cycles in part I of the study were analyzed,and 632 patients undergoing FET for the first time and using a Gn RH-a hormone replacement therapy were collected and enrolled.Patients were divided into live birth and non-live birth groups based on whether a live birth was achieved.By comparing live birth and non-live birth groups,Compared two groups of patients in the general clinical data,the main indicators to the stage of controlled ovarian hyperstimulation（the total number of Gn days,the total dose of Gn,the endometrial thickness of HCG day,etc.）,the main indicators to the stage of endometrial preparation（Gn RH-a dose,the total dose of estradiol valerate,the total number of estradiol valerate and the endometrial thickness of transplantation day,etc.）and auxiliary examination main indicators（blood routine,blood lipid four,etc.）To determine the influencing factors of live birth.Results: Female age,infertility type,the number of abortion and endometrial thickness on transplantation day were the important factors affecting live birth.Conclusion: Comparison between groups was used to analyze the outcome of live birth in patients who received FET for the first time and adopted Gn RH-a hormone replacement therapy.Through comprehensive analysis of the differences in general clinical data,the main indicators to the stage of controlled ovarian hyperstimulation,the main indicators to the stage of endometrial preparation and main indicators of auxiliary examination,it was found that the influencing factors of live birth were as follows: the number of previous abortion,endometrial thickness,infertility type,female age.