Abstract
Objective To develop and validate a prediction model for high ovarian response in in vitro fertilization-embryo transfer (IVF-ET) cycles. Methods Totally, 480 eligible outpatients with infertility who underwent IVF-ET were selected and randomly divided into the training set for developing the prediction model and the testing set for validating the model. Univariate and multivariate logistic regressions were carried out to explore the predictive factors of high ovarian response, and then, the prediction model was constructed. Nomogram was plotted for visualizing the model. Area under the receiver-operating characteristic (ROC) curve, Hosmer-Lemeshow test and calibration curve were used to evaluate the performance of the prediction model. Results Antral follicle count (AFC), anti-Müllerian hormone (AMH) at menstrual cycle day 3 (MC3), and progesterone (P) level on human chorionic gonadotropin (HCG) day were identified as the independent predictors of high ovarian response. The value of area under the curve (AUC) for our multivariate model reached 0.958 (95% CI: 0.936-0.981) with the sensitivity of 0.916 (95% CI: 0.863-0.953) and the specificity of 0.911 (95% CI: 0.858-0.949), suggesting the good discrimination of the prediction model. The Hosmer-Lemeshow test and the calibration curve both suggested model's good calibration. Conclusion The developed prediction model had good discrimination and accuracy via internal validation, which could help clinicians efficiently identify patients with high ovarian response, thereby improving the pregnancy rates and clinical outcomes in IVF-ET cycles. However, the conclusion needs to be confirmed by more related studies.
Highlights
With the rapid development of assisted reproductive technology (ART), in vitro fertilization-embryo transfer (IVFET) has become an important treatment for infertility [1]
Baseline characteristics of patients were collected in our study, of which categorical variables included smoking history, type of infertility, and pregnancy history; continuous variables contained age, body mass index (BMI), age at menarche, mean menstrual cycle, and duration of infertility; Antral follicle count (AFC), endometrial thickness, luteinizing hormone (LH) level, estradiol (E2) level, P level, follicle-stimulating hormone (FSH) level, and anti-Müllerian hormone (AMH) level on menstrual cycle day 3 (MC3); dosing days, initial dose, and total dose of Gn; endometrial thickness and hormone levels on the day of human chorionic gonadotropin (HCG) injection
AFC was assessed by transvaginal sonography at MC3; endometrial thickness was observed on the day of injection of HCG; LH was defined as a hormone secreted by basophils in the anterior pituitary gland; E2 was a steroidal estrogen with the normal value of follicular stage (94-433 pmol/L), the normal value of luteal phase (499-1580 pmol/L), and the normal value during ovulation (704-1580 pmol/L); P was defined as main progesterone with biological activity secreted by the ovary; FSH was a hormone secreted by basophils in the anterior pituitary gland that promoted follicle maturation; AMH was defined as a hormone secreted by follicles in the predeveloping chambers or small chambers of the ovary
Summary
With the rapid development of assisted reproductive technology (ART), in vitro fertilization-embryo transfer (IVFET) has become an important treatment for infertility [1]. Controlled ovarian hyperstimulation (COH) is a key step of IVF-ET, where gonadotropin (Gn) stimulates the development of multiple follicles and produces multiple mature oocytes, thereby improving pregnancy rates [2, 3]. It cannot be ignored that ovaries’ overreaction to Gn could increase the risk of iatrogenic complication-ovarian hyperstimulation syndrome (OHSS) [4], which is characterized by an increase in ovarian volume and brings more severe and even fatal infertility. It is still necessary to identify the risk of OHSS in IVF-ET for patients. Hormone level is higher in patients with high ovarian response, which is not conducive to endometrial receptivity and embryo implantation, thereby increasing the incidence of ovarian hyperstimulation syndrome (OHSS) [6].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
