Xu Huiyu, Feng Guoshuang, Wei Yuan, Feng Ying, Yang Rui, Wang Liying, Zhang Hongxia, Li Rong, Qiao Jie
Peking University Third Hospital, Beijing, China.
Beijing Children's Hospital, Beijing, China.
JMIR Med Inform. 2020 Apr 16;8(4):e17366. doi: 10.2196/17366.
Ectopic pregnancy (EP) is a serious complication of assisted reproductive technology (ART). However, there is no acknowledged mathematical model for predicting EP in the ART population.
The goal of the research was to establish a model to tailor treatment for women with a higher risk of EP.
From December 2015 to July 2016, we retrospectively included 1703 women whose serum human chorionic gonadotropin (hCG) levels were positive on day 21 (hCG21) after fresh embryo transfer. Multivariable multinomial logistic regression was used to predict EP, intrauterine pregnancy (IUP), and biochemical pregnancy (BCP).
The variables included in the final predicting model were (hCG21, ratio of hCG21/hCG14, and main cause of infertility). During evaluation of the model, the areas under the receiver operating curve for IUP, EP, and BCP were 0.978, 0.962, and 0.999, respectively, in the training set, and 0.963, 0.942, and 0.996, respectively, in the validation set. The misclassification rates were 0.038 and 0.045, respectively, in the training and validation sets. Our model classified the whole in vitro fertilization/intracytoplasmic sperm injection-embryo transfer population into four groups: first, the low-risk EP group, with incidence of EP of 0.52% (0.23%-1.03%); second, a predicted BCP group, with incidence of EP of 5.79% (1.21%-15.95%); third, a predicted undetermined group, with incidence of EP of 28.32% (21.10%-35.53%), and fourth, a predicted high-risk EP group, with incidence of EP of 64.11% (47.22%-78.81%).
We have established a model to sort the women undergoing ART into four groups according to their incidence of EP in order to reduce the medical resources spent on women with low-risk EP and provide targeted tailor-made treatment for women with a higher risk of EP.
异位妊娠（EP）是辅助生殖技术（ART）的一种严重并发症。然而，在ART人群中，尚无公认的预测EP的数学模型。
本研究的目的是建立一个模型，为EP风险较高的女性量身定制治疗方案。
2015年12月至2016年7月，我们回顾性纳入了1703名在新鲜胚胎移植后第21天血清人绒毛膜促性腺激素（hCG）水平呈阳性（hCG21）的女性。采用多变量多项逻辑回归来预测EP、宫内妊娠（IUP）和生化妊娠（BCP）。
最终预测模型纳入的变量为（hCG21、hCG21/hCG14比值和不孕的主要原因）。在模型评估过程中，IUP、EP和BCP在训练集中的受试者操作特征曲线下面积分别为0.978、0.962和0.999，在验证集中分别为0.963、0.942和0.996。训练集和验证集的错误分类率分别为0.038和0.045。我们的模型将整个体外受精/卵胞浆内单精子注射-胚胎移植人群分为四组：第一，低风险EP组，EP发生率为0.52%（0.23%-1.03%）；第二，预测BCP组，EP发生率为5.79%（1.21%-15.95%）；第三，预测不确定组，EP发生率为28.32%（21.10%-35.53%）；第四，预测高风险EP组，EP发生率为64.11%（47.22%-78.81%）。
我们建立了一个模型，根据EP发生率将接受ART的女性分为四组，以减少在低风险EP女性身上花费的医疗资源，并为EP风险较高的女性提供有针对性的量身定制治疗。
