Department of Cellular Biology, Functional Biology and Physical Anthropology, Faculty of Biological Sciences, University of Valencia, Dr. Moliner 50, Burjassot, 46100, Valencia, Spain.
Institute of Health Research INCLIVA, Valencia, Spain.
J Assist Reprod Genet. 2020 Jan;37(1):171-180. doi: 10.1007/s10815-019-01642-3. Epub 2019 Dec 3.
To introduce a prognostic model for women's assisted fecundity before starting the first IVF/ICSI treatment cycle.
In contrast to previous predictive models, we analyze two groups of women at the extremes of prognosis. Specifically, 708 infertile women that had either a live birth (LB) event in the first autologous IVF/ICSI cycle ("high-assisted-fecundity women", n = 458) or did not succeed in having a LB event after completing three autologous IVF/ICSI cycles ("low-assisted-fecundity women", n = 250). The initial sample of 708 women was split into two sets in order to develop (n = 531) and internally validate (n = 177) a predictive logistic regression model using a forward-stepwise variable selection.
Seven out of 32 initially selected potential predictors were included into the model: women's age, presence of multiple female infertility factors, number of antral follicles, women's tobacco smoking, occurrence of irregular menstrual cycles, and basal levels of prolactin and LH. The value of the c-statistic was 0.718 (asymptotic 95% CI 0.672-0.763) in the development set and 0.649 (asymptotic 95% CI: 0.560-0.738) in the validation set. The model adequately fitted the data with no significant over or underestimation of predictor effects.
Women's assisted fecundity may be predicted using a relatively small number of predictors. This approach may complement the traditional procedure of estimating cumulative and cycle-specific probabilities of LB across multiple complete IVF/ICSI cycles. In addition, it provides an easy-to-apply methodology for fertility clinics to develop and actualize their own predictive models.
在开始第一个试管婴儿/卵胞浆内单精子注射（ICSI）治疗周期之前，为女性的辅助生育能力引入一个预测模型。
与之前的预测模型不同，我们分析了预后处于两个极端的两组女性。具体来说，708 名患有不孕的女性中，有 458 名在第一次自体试管婴儿/ICSI 周期中发生了活产（LB）事件（“高辅助生育能力女性”），250 名在完成三个自体试管婴儿/ICSI 周期后未能成功发生 LB 事件（“低辅助生育能力女性”）。为了使用向前逐步变量选择方法开发（n=531）和内部验证（n=177）预测逻辑回归模型，将最初的 708 名女性样本分为两组。
在最初选择的 32 个潜在预测因素中，有 7 个被纳入模型：女性年龄、存在多种女性不孕因素、窦卵泡数、女性吸烟、月经周期不规则，以及催乳素和 LH 的基础水平。该模型在发展组中的 c 统计量为 0.718（渐近 95%CI：0.672-0.763），在验证组中的 c 统计量为 0.649（渐近 95%CI：0.560-0.738）。该模型能够很好地拟合数据，没有显著的预测因素效应高估或低估。
可以使用相对较少的预测因素来预测女性的辅助生育能力。这种方法可以补充传统的估计多个完整试管婴儿/ICSI 周期中 LB 累积和周期特异性概率的方法。此外，它为生育诊所提供了一种易于应用的方法来开发和实现自己的预测模型。
