A Validated Model for Individualized Prediction of Live Birth in Patients With Adenomyosis Undergoing Frozen-Thawed Embryo Transfer

Abstract

Background There is few predictive tools for live birth in women with adenomyosis, which provide further personalized and clinically specific information related to individualized decisions making during IVF/ICSI treatment. Methods A total of 424 patients with adenomyosis underwent frozen-thawed embryo transfer (FET) from Jan 2013 to Dec 2019 at a public university hospital were included. The patients were randomly divided into training (n = 265) and validation (n = 159) samples for the building and testing of the nomogram, respectively. Multivariate logistic regression (MLR) was developed on the basis of clinical covariates assessed for their association with live birth. Results In all, 183 (43.16%) patients became pregnant, and 114 (26.88%) had a live birth. In the multivariable analysis of the training cohort, probability of live birth was significantly correlated with the age < 37 years old (odds ratio [OR], 3.465; 95% CI, 1.215–9.885, P = 0.020), uterine volume prior ET < 102.02 cm3 (OR, 8.141; 95% CI, 2.170–10.542; P = 0.002), blastocyst transfer (OR, 3.231; 95% CI, 1.065–8.819, P = 0.023), twin pregnancy (OR, 0.328; 95% CI, 0.104–0.344, P = 0.005) and protocol in FET (P < 0.001). The statistical nomogram was built based on the five variates, age, uterine volume prior embryo transfer, twin pregnancy, stage of transferred embryo and protocol of FET, with an area under the curve (AUC) of 0.837 (95% confidence interval: 0.741–0.910) for the training cohort. The AUC for the validation cohort was 0.737 (95% confidence interval: 0.661–0.813), showing a satisfactory goodness-of-fit and discrimination ability in this nomogram. Conclusions Single blastocyst transfer, GnRH-a pretreated and smaller uterine size before embryo transfer contributed to increasing live birth rate in patients with adenomyosis. The user-friendly nomogram built on the risk factors of live birth in patients with adenomyosis, provides a useful guide for medical staff on individualized decisions making during the IVF/ICSI procedure.