PREDICTING PROBABILITY OF CUMULATIVE LIVE BIRTH BASED ON BOTH BASELINE INFORMATION AND PROTOCOLS OF CONTROLLED OVARIAN STIMULATION

Abstract

To develop a prediction model for the probability of cumulative live birth from one initiated assisted reproductive technology (ART) cycle based on couples’ baseline characteristics and controlled ovarian stimulation (COS) protocols. Therefore, we sought to create a clinical prediction model for counseling and COS protocol selection. A retrospective cohort study. From Jan 2012 to Mar 2016, all women at age of 19-39 years old with at least 5 antral follicle count (AFC) underwent just one complete ART cycle with long GnRH-agonist, depot GnRH-agonist, modified long GnRH agonist and GnRH-antagonist protocols in Chengdu Xi’nan Gynecology Hospital were included, and followed up to Mar 2018. Couples with chromosome abnormality were excluded. Cumulative live birth was defined as first live birth resulting from one initiated ART cycle, including cycles in which fresh and/or frozen embryos were transferred, until one delivery with a live birth occurs or until all embryos are used, whichever occurs first. A multivariate stepwise logistic regression model was used to predict the probability of cumulative live birth. The accuracy of the model was then tested using a receiver operating characteristic curve (ROC). 6862 patients with 6862 complete ART cycle were enrolled with a 72.89% overall cumulative live birth rate (CLBR), namely 5002 cycles cumulatively had live birth. Predictors in the model were female’s age (-0.07, 95% CI:-0.09∼-0.05, P<0.001), height (0.06, 95% CI:0.05∼0.08, P<0.001), weight (-0.01, 95% CI:-0.02∼0.00 , P=0.005), duration of infertility (-0.06, 95% CI:-0.08∼-0.04 , P<0.001), number of previous ART cycle (-0.60, 95% CI:-0.79∼-0.41 , P<0.001), basal AFC (0.08, 95% CI:0.07∼0.09, P<0.001), basal FSH (-0.09, 95% CI:-0.12∼-0.06, P<0.001) and COS protocols [long GnRH-agonist (reference category), depot GnRH-agonist (-0.08, 95% CI:-0.64∼0.48, P=0.785), modified long GnRH agonist (-0.69, 95% CI:-0.96∼-0.43 , P<0.001), GnRH-antagonist protocols (-0.12, 95% CI:-0.71∼0.47, P=0.696)]. The area under the curve (AUC) for ROC was 0.708. This model provides a scientific predicting method for probability of cumulative live birth, thus help doctors give patients more accurate counseling and select more suitable COS protocol.