Objective:To explore risk factors associated with the live birth in patients with long-acting follicular phase in fresh single embryo transfer cycle and to construct nomogram prediction model for providing a reference for clinical decision-making and individualized treatment.Methods:An assisted reproduction population-based retrospective cohort analysis of the clinical data of 2 795 patients with long-acting follicular phase in fresh single embryo transfer cycle who underwent in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) was performed in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2020. These patients were randomly divided into modeling group and validation group according to 3∶1. Univariate and multivariate logistic regression were used to screen potential risk factors for newborn live birth after fresh single embryo transfer. The nomogram model was established according to the regression coefficients. Besides, area under the receiver operator characteristic (ROC) curve, calibration curve and decision curve analysis were used to evaluate the discrimination and calibration of the model. Results:Through multiple logistic regression analysis, female age, progestational polycystic ovary syndrome (PCOS), the level of progestrogen on the day of human chorionic gonadotropin (hCG) injection, high-quality embryo rate, type of embryos transferred were independent risk factors associated with live birth. Stratified analysis found age ≥36 years together with the level of progestrogen ≥5.20 nmol/L on the day of hCG injection could reduce the probability of live birth signally, and statistically significant interaction was found ( P=0.043). The level of progestrogen ≥5.20 nmol/L on the day of hCG injection together with high-quality embryo rate <59.60% could reduce the probability of live birth signally, and statistically significant interaction was found ( P=0.010). The area under the curve (AUC) of modeling group and validation group was 0.637 (95% CI: 0.615-0.658) and 0.617 (95% CI: 0.579-0.654), respectively. The calibration curve showed that the predicted value of the model was in good agreement with the actual value. The decision curve analysis indicated the most benefical clinical effect with the nomogram for live birth under threshold probabilities of 24.05%-68.75%, it had a good diagnostic value for clinical decision. Conclusion:Female age, progestational PCOS, the level of progestrogen on the day of hCG injection, high-quality embryo rate, type of embryos transferred were independent risk factors associated with live birth in patients with long-acting follicular phase in fresh single embryo transfer cycle. Female age ≥36 years and high-quality embryo rate <59.60% together with the level of progestrogen ≥5.26 nmol/L on the day of hCG injection respectively could reduce the probability of live birth. The nomogram predictive model based on the above factors contribute to predict the probability of live birth.

Objective:To explore risk factors associated with the live birth in patients with long-acting follicular phase in fresh single embryo transfer cycle and to construct nomogram prediction model for providing a reference for clinical decision-making and individualized treatment.Methods:An assisted reproduction population-based retrospective cohort analysis of the clinical data of 2 795 patients with long-acting follicular phase in fresh single embryo transfer cycle who underwent in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET) was performed in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2020. These patients were randomly divided into modeling group and validation group according to 3∶1. Univariate and multivariate logistic regression were used to screen potential risk factors for newborn live birth after fresh single embryo transfer. The nomogram model was established according to the regression coefficients. Besides, area under the receiver operator characteristic (ROC) curve, calibration curve and decision curve analysis were used to evaluate the discrimination and calibration of the model. Results:Through multiple logistic regression analysis, female age, progestational polycystic ovary syndrome (PCOS), the level of progestrogen on the day of human chorionic gonadotropin (hCG) injection, high-quality embryo rate, type of embryos transferred were independent risk factors associated with live birth. Stratified analysis found age ≥36 years together with the level of progestrogen ≥5.20 nmol/L on the day of hCG injection could reduce the probability of live birth signally, and statistically significant interaction was found ( P=0.043). The level of progestrogen ≥5.20 nmol/L on the day of hCG injection together with high-quality embryo rate <59.60% could reduce the probability of live birth signally, and statistically significant interaction was found ( P=0.010). The area under the curve (AUC) of modeling group and validation group was 0.637 (95% CI: 0.615-0.658) and 0.617 (95% CI: 0.579-0.654), respectively. The calibration curve showed that the predicted value of the model was in good agreement with the actual value. The decision curve analysis indicated the most benefical clinical effect with the nomogram for live birth under threshold probabilities of 24.05%-68.75%, it had a good diagnostic value for clinical decision. Conclusion:Female age, progestational PCOS, the level of progestrogen on the day of hCG injection, high-quality embryo rate, type of embryos transferred were independent risk factors associated with live birth in patients with long-acting follicular phase in fresh single embryo transfer cycle. Female age ≥36 years and high-quality embryo rate <59.60% together with the level of progestrogen ≥5.26 nmol/L on the day of hCG injection respectively could reduce the probability of live birth. The nomogram predictive model based on the above factors contribute to predict the probability of live birth.