Reproductive Medicine Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, Guangdong, China.
Reproductive Medicine Center, The Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, Guangdong, China.
Reprod Biol Endocrinol. 2021 Jan 7;19(1):6. doi: 10.1186/s12958-020-00693-x.
Women who conceived with in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) are more likely to experience adverse pregnancy outcomes than women who conceived naturally. Cervical insufficiency (CI) is one of the important causes of miscarriage and premature birth, however there is no published data available focusing on the potential risk factors predicting CI occurrence in women who received IVF/ICSI treatment. This study aimed to identify the risk factors that could be integrated into a predictive model for CI, which could provide further personalized and clinically specific information related to the incidence of CI after IVF/ICSI treatment.
This retrospective study included 4710 patients who conceived after IVF/ICSI treatment from Jan 2011 to Dec 2018 at a public university hospital. The patients were randomly divided into development (n = 3108) and validation (n = 1602) samples for the building and testing of the nomogram, respectively. Multivariate logistic regression was developed on the basis of pre-pregnancy clinical covariates assessed for their association with CI occurrence.
A total of 109 patients (2.31%) experienced CI among all the enrolled patients. Body mass index (BMI), basal serum testosterone (T), gravidity and uterine length were associated with CI occurrence. The statistical nomogram was built based on BMI, serum T, gravidity and uterine length, with an area under the curve (AUC) of 0.84 (95% confidence interval: 0.76-0.90) for the developing cohort. The AUC for the validation cohort was 0.71 (95% confidence interval: 0.69-0.83), showing a satisfactory goodness-of-fit and discrimination ability in this nomogram.
The user-friendly nomogram which graphically represents the risk factors and a pre-pregnancy predicted tool for the incidence of CI in patients undergoing IVF/ICSI treatment, provides a useful guide for medical staff on individualized decisions making, where preventive measures could be carried out during the IVF/ICSI procedure and subsequent pregnancy.
通过体外受精（IVF）或卵胞浆内单精子注射（ICSI）受孕的女性比自然受孕的女性更有可能出现不良妊娠结局。宫颈机能不全（CI）是流产和早产的重要原因之一，然而，目前尚无针对接受 IVF/ICSI 治疗的女性发生 CI 的潜在危险因素的相关数据。本研究旨在确定可纳入预测模型的危险因素，以提供与 IVF/ICSI 治疗后 CI 发生率相关的进一步个性化和特定于临床的信息。
本回顾性研究纳入了 2011 年 1 月至 2018 年 12 月在一所公立大学医院接受 IVF/ICSI 治疗后受孕的 4710 名患者。患者被随机分为发展（n = 3108）和验证（n = 1602）样本，分别用于建立和测试列线图。基于孕前临床协变量进行多变量逻辑回归，评估其与 CI 发生的相关性。
所有纳入患者中，共有 109 例（2.31%）发生 CI。体质量指数（BMI）、基础血清睾酮（T）、孕次和子宫长度与 CI 发生相关。基于 BMI、血清 T、孕次和子宫长度建立了统计列线图，发展队列的曲线下面积（AUC）为 0.84（95%置信区间：0.76-0.90）。验证队列的 AUC 为 0.71（95%置信区间：0.69-0.83），表明该列线图具有良好的拟合度和区分能力。
该易于使用的列线图直观地显示了接受 IVF/ICSI 治疗的患者发生 CI 的危险因素和孕前预测工具，为医务人员提供了有价值的个体化决策指导，以便在 IVF/ICSI 过程和随后的妊娠中实施预防措施。
