Nomogram models to predict low fertilisation rate and total fertilisation failure in patients undergoing conventional IVF cycles

Abstract

Objectives: To establish visualised prediction models of low fertilisation rate (LFR) and total fertilisation failure (TFF) for patients in conventional in vitro fertilisation (IVF) cycles.

Design: A retrospective cohort study.

Setting: Data from August 2017 to August 2021 were collected from the electronic records of a large obstetrics and gynaecology hospital in Sichuan, China.

Participants: A total of 11 598 eligible patients who underwent the first IVF cycles were included. All patients were randomly divided into the training group (n=8129) and the validation group (n=3469) in a 7:3 ratio.

Primary outcome measure: The incidence of LFR and TFF.

Results: Logistic regressions showed that ovarian stimulation protocol, primary infertility and initial progressive sperm motility were the independent predictors of LFR, while serum luteinising hormone and P levels before human chorionic gonadotropin injection and number of oocytes retrieved were the critical predictors of TFF. And these indicators were incorporated into the nomogram models. According to the area under the curve values, the predictive ability for LFR and TFF were 0.640 and 0.899 in the training set and 0.661 and 0.876 in the validation set, respectively. The calibration curves also showed good concordance between the actual and predicted probabilities both in the training and validation group.

Conclusion: The novel nomogram models provided effective methods for clinicians to predict LFR and TFF in traditional IVF cycles.

Keywords: epidemiology; reproductive medicine; subfertility.

Figure 1

Nomogram models to predict the risk of (A) low fertilisation rate (LFR) and (B) total fertilisation failure (TFF). The independent predictors of LFR are ovarian stimulation protocols (a: GnRH antagonist, b: follicular phase GnRH agonist, c: luteal phase GnRH agonist, d: progesterone primed ovarian stimulation), primary infertility and initial progressive sperm motility. The independent predictors of TFF are LH on HCG day, P on HCG day and number of retrieved oocytes. GnRH, gonadotropin-releasing hormone; HCG, human chorionic gonadotropin; LH, luteinising hormone; LHOFHCG; LH on HCG day; P, progesterone; POFHCG, P on HCG day.

Figure 2

Receiver operating characteristic (ROC) curves for the prediction of low fertilisation rate (LFR) and total fertilisation failure (TFF) in the training group (A) and the validation group (B). AUC, area under the curve.

Figure 3

Calibration plots of the nomogram models for the prediction of (A) low fertilisation rate and (B) total fertilisation failure in the training group.

Figure 4

Calibration plots of the nomogram models for the prediction of (A) low fertilisation rate and (B) total fertilisation failure in the validation group.