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Si M, Jiang H, Zhao Y, Qi X, Li R, Long X, Qiao J. Nomogram for Predicting Live Birth after the First Fresh Embryo Transfer in Patients with PCOS Undergoing IVF/ICSI Treatment with the GnRH-Ant Protocol. Diagnostics (Basel) 2023; 13:diagnostics13111927. [PMID: 37296779 DOI: 10.3390/diagnostics13111927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Polycystic ovary syndrome (PCOS) is the leading cause of anovulatory infertility. A better understanding of factors associated with pregnancy outcomes and successful prediction of live birth after IVF/ICSI are important to guide clinical practice. This was a retrospective cohort study investigating live birth after the first fresh embryo transfer using the GnRH-ant protocol in patients with PCOS between 2017 and 2021 at the Reproductive Center of Peking University Third Hospital. A total of 1018 patients with PCOS were qualified for inclusion in this study. BMI, AMH level, initial FSH dosage, serum LH and progesterone levels on the hCG trigger day, and endometrial thickness were all independent predictors of live birth. However, age and infertility duration were not significant predictors. We developed a prediction model based on these variables. The predictive ability of the model was demonstrated well, with areas under the curve of 0.711 (95% CI, 0.672-0.751) and 0.713 (95% CI, 0.650-0.776) in the training cohort and validation cohort, respectively. Additionally, the calibration plot showed good agreement between the prediction and the observation (p = 0.270). The novel nomogram could be helpful for clinicians and patients in clinical decision-making and outcome evaluation.
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Affiliation(s)
- Manfei Si
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Huahua Jiang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Yue Zhao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Xinyu Qi
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Rong Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Xiaoyu Long
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing 100191, China
- Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education, Beijing 100191, China
- Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing 100191, China
- Beijing Advanced Innovation Center for Genomics, Beijing 100191, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100191, China
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Wang X, Xiao Y, Zhou Y, Wang H. Development speed of sibling embryo positively reflects live birth rate after fresh day 3 embryo transfer. Sci Rep 2023; 13:6402. [PMID: 37076577 PMCID: PMC10115796 DOI: 10.1038/s41598-023-33573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/14/2023] [Indexed: 04/21/2023] Open
Abstract
The ability of sibling embryos to form blastocysts may reflect the developmental potential of the embryos that were transferred into the uterus. The purpose of the study was to investigate whether the development speed of sibling embryos positively reflects the live birth rate following fresh embryo transfer. We examined 1262 cycles of women who underwent day 3 (D3) cleavage embryo transfer in the Peking Union Medical College Hospital in 2015-2020, who were divided into three groups (D5, D5 + D6, and D6) according to blastocyst formation. The live birth rate in patients with blastocysts that formed on D6 was significantly lower than the other two groups (36.1%, 45.6% and 44.7%, P < 0.05). For women with blastocysts that formed on D6, the live birth rate was higher in those with more good quality blastocysts than poor-quality blastocysts (42.4 vs 32.3%, P < 0.05). Multiple regression analysis showed that the blastocyst development speed of sibling embryos was an independent factor affecting live birth after fresh embryo transfer (P < 0.05). We concluded that the blastocyst development speed of sibling embryos may reflect live birth rate following the transfer of D3 cleavage embryos.
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Affiliation(s)
- Xue Wang
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
| | - Yaling Xiao
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Yuanzheng Zhou
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Hanbi Wang
- Department of Gynaecology Endocrine and Reproductive Centre, State Key Laboratory of Complex Severe and Rare Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
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Association of the Cumulative Live Birth Rate with the Factors in Assisted Reproductive Technology: A Retrospective Study of 16,583 Women. J Clin Med 2023; 12:jcm12020493. [PMID: 36675422 PMCID: PMC9862593 DOI: 10.3390/jcm12020493] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/01/2023] [Accepted: 01/05/2023] [Indexed: 01/11/2023] Open
Abstract
The cumulative live birth rate (CLBR) can better reflect the overall treatment effect by successive treatments, and continuous rather than categorical variables as exposure variables can increase the statistical power in detecting the potential correlation. Therefore, the dose-response relationships might find an optimal dose for the better CLBR, offering evidence-based references for clinicians. To determine the dose-response relationships of the factors and the optimal ranges of the factors in assisted reproductive technology (ART) associated with a higher CLBR, this study retrospectively analyzed 16,583 patients undergoing the first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) from January 2017 to January 2019. Our study demonstrated the optimal ranges of age with a higher CLBR were under 32.10 years. We estimated the CLBR tends to increase with increased levels of AMH at AMH levels below 1.482 ng/mL, and the CLBR reaches a slightly high level at AMH levels in the range from 2.58-4.18 ng/mL. The optimal ranges of basal FSH with a higher CLBR were less than 9.13 IU. When the number of cryopreserved embryos was above 1.055 and the number of total transferred embryos was 2, the CLBR was significantly higher. In conclusion, there is a non-linear dose-response relationship between the CLBR with age, AMH, basal FSH, and the number of cryopreserved embryos and total transferred embryos. We proposed the optimal ranges of the five factors that were correlated with a higher CLBR in the first oocyte retrieval cycle, which may help consultation at IVF clinics.
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Aslan K, Kasapoglu I, Cakir C, Avci B, Uncu G. Supernumerary embryos, do they show the cycle success in a fresh embryo transfer? A retrospective analysis. Gynecol Endocrinol 2021; 37:1107-1110. [PMID: 34232093 DOI: 10.1080/09513590.2021.1946502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To determine the predictive value of cryopreserved embryos during single fresh blastocyst transfer. METHODS This retrospective cohort study was conducted at a tertiary university hospital ART center. Patients who underwent a single fresh blastocyst transfer were selected from the electronic database. Patients with diminished ovarian reserve, uterine pathology, advanced age (>40 years) were excluded from the study. Patients were divided into two groups. Group A consisted of patients with only one available embryo for the fresh transfer. Group B consisted of patients with cryopreserved embryos apart from the fresh transferred embryo. Demographic and embryology parameters, pregnancy results were compared. RESULTS Demographic values, ovarian reserve parameters were comparable between groups. The number of the picked-up oocyte, metaphase-2 oocyte, and two-pronucleus embryo was lower in Group A. Positive pregnancy rates were two-fold higher in Group B (23.4% vs. 50.9% p < .01). Pregnancy results did not change depending on the number of cryopreserved embryos in Group B. CONCLUSION According to our results, the presence of cryopreserved embryos results in higher pregnancy rates in patients with fresh blastocyst embryo transfer independent from the woman's age and ovarian reserve. Thus, these results may help us to predict the implantation rate before embryo transfer.
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Affiliation(s)
- Kiper Aslan
- Department of Obstetrics & Gynecology, ART Center, Bursa Uludag University School of Medicine, Gorukle, Turkey
| | - Isil Kasapoglu
- Department of Obstetrics & Gynecology, ART Center, Bursa Uludag University School of Medicine, Gorukle, Turkey
| | - Cihan Cakir
- Department of Histology & Embryology, Bursa Uludag University School of Medicine, Gorukle, Turkey
| | - Berrin Avci
- Department of Histology & Embryology, Bursa Uludag University School of Medicine, Gorukle, Turkey
| | - Gurkan Uncu
- Department of Obstetrics & Gynecology, ART Center, Bursa Uludag University School of Medicine, Gorukle, Turkey
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Ibrahim Y, Stoddard GJ, Johnstone E. A validated prediction score for having two or more embryos for cryopreservation following freeze-all IVF cycles: an analysis utilizing SART CORS database. J Assist Reprod Genet 2020; 38:397-405. [PMID: 33241427 DOI: 10.1007/s10815-020-02018-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/16/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To develop and validate a prediction score for having 2 or more embryos cryopreserved following an IVF cycle without a fresh transfer such that an embryo selection method may be applicable. We also developed a counseling tool on the probability of not having any embryos following an IVF cycle without a fresh transfer. METHODS We split the data into a development set and a validation set by region within the USA using a coin flip approach and subsequently performed a logistic regression model to identify factors most predictive of cryopreservation of 2 or more embryos in the development set. This model was validated in the validation set. Subsequently, a clinical prediction score was derived using the model coefficients and the predictive accuracy measured with the concordance (c) statistic. RESULTS A total of 31,537 potential freeze-all cycles were reported to the Society for Assisted Reproductive Technology in 2014. Of these, 57.87% produced and cryopreserved two or more embryos. We identified that age, AMH, and the number of eggs retrieved were the most significant predictors of having 2 or more embryos cryopreserved with a validated c-statistic of 0.84 (95% CI: 0.83 to 0.85). A clinical prediction score was derived from the model. 28.9% of freeze-all cycles had no embryos created from the IVF cycle despite a cycle start and an egg retrieval. The number of eggs retrieved was the most significant predictor of having no embryos available for a transfer, with a c-statistic of 0.80 when modeled as the only predictor variable. CONCLUSION We derived counseling tools with acceptable discrimination for use in clinical practice (c-statistics > 0.7). Our study further suggests that the number of eggs retrieved from an IVF cycle is most predictive of having 2 or more embryos cryopreserved and not having any embryos after an IVF cycle, suggesting that clinicians should strive to optimize oocyte yield especially in poor prognosis patients. The probability of having two more embryos cryopreserved in a freeze-all IVF cycle such that an embryo selection method is applicable can be predicted with acceptable precision prior to the IVF cycle and excellent precision following egg retrieval using the prediction score.
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Affiliation(s)
- Yetunde Ibrahim
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, School of Medicine, Salt Lake City, UT, USA.
| | - Gregory J Stoddard
- Department of Internal Medicine, University of Utah, School of Medicine, Salt Lake City, UT, USA
| | - Erica Johnstone
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Utah, School of Medicine, Salt Lake City, UT, USA
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Xiong F, Wang S, Sun Q, Ye L, Yao Z, Chen P, Wan C, Zhong H, Zeng Y. A visualized clinical model predicting good quality blastocyst development in the first IVF/ICSI cycle. Reprod Biomed Online 2020; 41:807-817. [PMID: 32843308 DOI: 10.1016/j.rbmo.2020.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/04/2020] [Accepted: 07/16/2020] [Indexed: 11/15/2022]
Abstract
RESEARCH QUESTION Is it possible to establish a visualized clinical model predicting good quality blastocyst (GQB) formation for patients in their first IVF/intracytoplasmic sperm injection (ICSI) cycle? DESIGN A total of 4783 patients in their first IVF/ICSI cycle between January 2015 and December 2019 were retrospectively included and randomly divided into the training set (n = 3826) and the testing set (n = 957) in an 8:2 ratio. The least absolute shrinkage and selection operator (LASSO) regression was adopted to select the most critical predictors for GQB formation to construct a visualized nomogram model based on the data of patients in the training set. Receiver operating characteristic and calibration curves were used to evaluate the predictive accuracy and discriminative ability. The performance of the model was also validated on independent data from patients treated in the testing set. RESULTS Maternal age, maternal serum anti-Müllerian hormone (MsAMH) concentration and the number of oocytes retrieved were highlighted as critical predictors of GQB development and were incorporated into the nomogram model. Based on the area under the curve (AUC) values, the predictive ability for ≥1, ≥3 and ≥5 GQB were 0.831, 0.734 and 0.748, respectively. The calibration curve also showed high concordance between the observed and predicted results. The AUC for predicting ≥1, ≥3 and ≥5 GQB in the testing set were 0.805, 0.695 and 0.707, respectively, which were similar to those for the training set. CONCLUSIONS The visualized nomogram model provides great predictive value for GQB development in patients in their first IVF/ICSI cycle and can be used to improve clinical counselling.
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Affiliation(s)
- Feng Xiong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Sisi Wang
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Qing Sun
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Lijun Ye
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Zhihong Yao
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Peilin Chen
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Caiyun Wan
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Huixian Zhong
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China
| | - Yong Zeng
- Shenzhen Key Laboratory of Reproductive Immunology for Peri-Implantation, Shenzhen Zhongshan Institute for Reproduction and Genetics, Fertility Center, Shenzhen Zhongshan Urology Hospital, Shenzhen Guangdong 518045, People's Republic of China.
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