Multivariate Analysis of Pregnancy Outcomes in Patients Undergoing Fresh Cleavage-stage Embryo Transfer and Construction of a Prediction Model

LEI Min; HUANG Kaishu; TANG Bin; GUO Yabin; WEN Li; ZHANG Ling

doi:10.16458/j.cnki.1007-0893.2025.16.003

Abstract：Objective To analyze the independent influencing factors of clinical pregnancy in patients undergoing fresh cleavage-stage embryo transfer and construct a nomogram prediction model to optimize individualized treatment strategies.Methods This study retrospectively analyzed the clinical data of 1708 patients who underwent in vitro fertilization/intracytoplasmic sperm injection combined with embryo transfer(IVF/ICSI-ET)and fresh cleavage-stage embryo transfer at the Reproductive Medicine Center of Changde Hospital Affiliated to Xiangya School of Medicine,Central South University from January 2019 to March 2023.The patients were randomly divided into a modeling group(1196 cases)and a validation group(512 cases)at a ratio of 7:3.The data of the modeling group were analyzed.With clinical pregnancy as the outcome variable,univariate Logistic regression analysis was first conducted,followed by variable selection using Lasso regression to establish a multivariate Logistic prediction model and draw a nomogram.The discrimination and calibration of the nomogram were evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),calibration curves,and decision curve analysis(DCA).Results Multivariate Logistic regression analysis showed that age,antral follicle count,high-quality embryo rate,endometrial thickness on the day of human chorionic gonadotropin(HCG),and the number of transferred embryos were independent influencing factors of clinical pregnancy.The nomogram model constructed based on these factors demonstrated good performance in both the modeling and validation groups:in terms of discrimination,the AUC of the ROC was 0.767(95%CI:0.740～0.794)and 0.740(95%CI:0.697～0.783),respectively;in terms of calibration,the Hosmer-Lemeshow test results showed no significant difference(P=0.676 in the modeling group and P=0.629 in the validation group);DCA further confirmed that the model had positive clinical net benefit and could effectively assist clinical decision-making.Conclusion Age,antral follicle count,high-quality embryo rate,endometrial thickness on the day of HCG,and the number of transferred embryos are independent influencing factors of clinical pregnancy.The nomogram constructed based on these factors is helpful in predicting the pregnancy success rate of patients undergoing fresh cleavage-stage embryo transfer.