新鲜周期卵裂期胚胎移植妊娠结局的列线图模型建立及预测分析OA

Objectives:To identify the independent factors influencing clinical outcomes of fresh-cycle cleavage-stage embryo transfer and to develop a nomogram prediction model with predictive performance analysis. Methods:A retrospective analysis was conducted on 543 cycles of patients who underwent fresh-cycle cleavage-stage embryo transfer at the Reproductive Medicine Department of Shanxi Provincial People's Hospital between March 2021 and May 2024.Qualified treatment cycles were randomly allocated(3∶1)to model development and validation cohorts.Independent predictors of clinical pregnancy were identified through univariate and multivariate binary logistic regression analyses.The R4.4.1 software package was used to establish a prediction model.Model discrimination was assessed via receiver operating characteristic(ROC)analysis,while predictive accuracy was evaluated using area under the curve(AUC)statistics and calibration plots. Results:The modeling and validation groups differed only in the distribution of infertility types(P＜0.05).Univariate and multivariate logistic regression analyses revealed that infertility type,basal follicle-stimulating hormone(FSH)level,endometrial thickness on the day of transfer,and the number of high-quality embryos transferred were independent factors influencing clinical pregnancy(P＜0.05).The infertility type,basal FSH level,and the number of high-quality embryos transferred were independent influencing factors for live birth(P＜0.05).The AUC values for the model group and the validation group,based on the predicted probabilities from the clinical pregnancy nomogram model,were 0.644[95％CI(0.592,0.696)]and 0.715[95％CI(0.619,0.810)],respectively.The calibration curve analysis revealed a practical linear relationship between the model-predicted probabilities and the actual ones. Conclusions:The prediction model constructed based on the infertility type,basal FSH level,endometrial thickness on the day of embryo transfer,and the number of high-quality embryos transferred can effectively forecast pregnancy outcomes following fresh-cycle cleavage-stage embryo transfer,demonstrating significant clinical utility and providing a valuable reference for clinical decision-making.