Ectopic pregnancy following in vitro fertilization-embryo transfer: A retrospective diagnostic study to develop a predictive nomogram

Ectopic pregnancy following in vitro fertilization-embryo transfer: A retrospective diagnostic study to develop a predictive nomogram | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Ectopic pregnancy following in vitro fertilization-embryo transfer: A retrospective diagnostic study to develop a predictive nomogram Sang He, Bing Xie, ShengHui Cao, Chen Luo, Jiao Lin, ShunQiang Zhou, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3333439/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Objective This study aimed to investigate the risk factors associated with ectopic pregnancy (EP) following in vitro fertilization-embryo transfer (IVF-ET) to establish a model to predict the risk of EP. Methods This retrospective cohort study was conducted in our hospital between January 2010 and December 2020. The enrolled dataset was randomly divided into two: a training cohort (65%, N = 603) and validation cohort (35%, N = 331). Clinical characteristics and laboratory indexes were associated with EP following IVF-ET based on univariate and multivariate analyses, and nomograms for predicting EP were established. Discrimination and calibration were assessed using the concordance (C)-index and a calibration curve. Results Multivariate logistic regression analysis showed that female factors, previous ectopic pregnancy, high estrogen levels, frozen-thawed embryo transfer, and low human chorionic gonadotropin levels at 14 days post embryo transfer were risk factors for EP. Multivariate logistic regression analysis was used to develop the nomogram. A C-index of 0.819 and 0.882 in the training and validation cohorts respectively, indicated the model had reliable discrimination, and the calibration plot overlapped the diagonal reference line of perfect calibration, indicating effective calibration. Conclusions We developed and validated a nomogram for predicting the probability of EP that provides clinicians with a quantitative tool. ectopic pregnancy in vitro fertilization-embryo transfer risk factors nomogram Figures Figure 1 Figure 2 Figure 3 Figure 4 INTRODUCTION Ectopic pregnancy (EP) is a common acute abdominal disease and one of the main causes of maternal death during the first trimester of pregnancy. 1 Approximately 1–2% of spontaneous pregnancies are ectopic, 2 and with the increased use of assisted reproductive technology (ART), the incidence is rising to 2.1–8.6%. 3 Failure of assisted pregnancy due to EP can cause stress in couples, especially if multiple treatment cycles are required. However, the reasons for the increased risk of EP during in vitro fertilization (IVF) are not entirely known. Therefore, researchers are paying increasing attention to the high-risk factors for EP following IVF and investigating measures to reduce the risk of EP. A previous study revealed that EP may be influenced by a history of cesarean section, smoking, infertility, EP, and oral contraceptives. 4 Some studies have shown that the probability of EP varies between frozen-thawed embryo transfer (FET) and fresh embryo transfer, cleavage-stage embryo transfer, and blastocyst transfer. 3 Nevertheless, we still lack an intuitive EP risk prediction model that can provide recommendations for EP-risk patients. Therefore, the factors that can be used as risk factors for EP in assisted reproduction are still debated. It is also desirable to create a quantifiable model to predict the occurrence of EP. Therefore, the aim of this study was to explore more sensitive risk factors for EP and to develop a predictive model for the potential risk of EP. MATERIALS AND METHODS Study designs and subjects This retrospective analysis was conducted on couples who received IVF/ intracytoplasmic sperm injection (ICSI) treatment at the Reproductive Center of Xiangtan Central Hospital between January 2010 and December 2020. According to the principle of 1:3 random re-sampling, a total of 934 cases were divided into the EP group (N = 239) and the intrauterine pregnancy (IUP) group (N = 695). The exclusion criteria were: patients with failed transplantation, slow FET cycle, embryos transferred on day 2 or 4 or twice in the same cycle, or patients lost to follow-up after transplantation. A flow chart selection is given in Fig. 1 . All patients were treated using the conventional ovulation promotion protocol of our center. When two-thirds of major follicles reach an average diameter of 18 mm, human chorionic gonadotropin (HCG) is administered to trigger oocyte maturation. After 36 h, the oocytes were aspirated transvaginally under ultrasound guidance. Conventional IVF or ICSI was used depending on the semen quality. After in vitro culture for 3–6 days, these embryos were transferred or frozen; frozen-thawed embryos were then transferred at the appropriate time. Hormone replacement cycles were used to prepare the endometrium during freeze-thaw cycles. After embryo transfer, all patients received HCG injections or vaginal progesterone soft capsules (Besins Manufacturing Belgium, Spain, 100 mg) for luteal support. Serum HCG level was measured on day 14 following embryo transfer, and luteal support was continued in HCG-positive individuals. Clinical pregnancy was diagnosed by vaginal ultrasound 28 days after transplantation, when the gestational sac, yolk sac, and heartbeat were observed. EP was diagnosed if there were masses, cysts, or a fetal heartbeat outside the uterus. Demographic data, history of risk factors, laboratory findings, and ultrasound findings were reviewed and recorded for a total of 22 factors. All factors were extracted and selected from a literature review to obtain the statistical significance related to our findings. This study was approved by the Ethics Committee of Xiangtan Central Hospital, and all patients provided written informed consent. Statistical analysis Datasets were divided in a 65:35 ratio into training and validation cohorts. Training cohorts were used to build models, and validation cohorts were used to validate the models. Statistical analysis was performed using R software version 3.6.3, using either the chi-square test for counting data, or a non-parametric test for measurement or grade data. Risk factors related to EP were analyzed using univariate logistic regression followed by multivariate logistic regression. The coefficients of the factors selected by multivariate logistic regression were used to develop a nomogram prediction model. The statistical significance of the difference was determined as P < 0.05. Based on the concordance (C)-index, the discrimination ability of the models was evaluated. A C-index (0.5 ≤ C-index ≤ 1) of 0.5 suggests no predictive discrimination, while an index of 1.0 indicates perfect discrimination. Calibration curves were used to estimate the calibration efficiency of the model. A calibration curve was constructed to evaluate the consistency between the predicted and observed probabilities. The 45° line represents the best prediction, and coincidence represents a better prediction. Finally, diagnostic analysis was performed using receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROC curves represents the prediction accuracy of our nomogram prediction model, where an AUC value of 0.5, represents a matter of chance, while an AUC value of 1 indicates perfect accuracy. RESULTS Patients’ characteristics In total, 934 patients were included in this study. Random sampling of the patient group was used to separate them into training (N = 603) and validation cohorts (N = 331). Table 1 shows the training and validation sets were comparable. Table 1 Baseline characteristics in the training and validation cohort Factors Training cohort (N = 603) Validation cohort(N = 331 ) P -value Age(y) 30.9 ± 4.31 31.2 ± 4.75 0.239 BMI(kg/㎡) 22.6 ± 3.38 22.2 ± 2.98 0.080 FSH(µg/mL) 6.74 ± 2.50 6.75 ± 2.47 0.990 Infertility factors: 0.765 Others 82 (13.6%) 50 (15.1%) Male 30 (4.98%) 18 (5.44%) Female(Pelvic fallopian tube) 491 (81.4%) 263 (79.5%) Number of pregnancy: 1.000 No 241 (40.0%) 133 (40.2%) Yes 362 (60.0%) 198 (59.8%) Number of births: 0.959 One time 104 (17.2%) 59 (17.8%) Many times 10 (1.66%) 6 (1.81%) None 489 (81.1%) 266 (80.4%) Ectopic pregnancy numbers: 0.373 One time 74 (12.3%) 49 (14.8%) Many times 47 (7.79%) 20 (6.04%) None 482 (79.9%) 262 (79.2%) Treatment: 0.982 Medication 490 (81.3%) 268 (81.0%) Operation 113 (18.7%) 63 (19.0%) Cesarean section numbers: 0.441 No 555 (92.0%) 299 (90.3%) Yes 48 (7.96%) 32 (9.67%) Intrauterine factors: 1.000 Normal 417 (69.2%) 229 (69.2%) Abnormal 186 (30.8%) 102 (30.8%) Conditions of Fallopian tubes: 0.155 Others 59 (9.78%) 36 (10.9%) Bilateral obstruction 493 (81.8%) 255 (77.0%) Bilateral patency 51 (8.46%) 40 (12.1%) Mycoplasma: 0.442 No 516 (85.6%) 290 (87.6%) Yes 87 (14.4%) 41 (12.4%) History of pelvic and abdominal surgery: 1.000 No 319 (52.9%) 175 (52.9%) Yes 284 (47.1%) 156 (47.1%) Protocol of controlled ovarian hyperstimulatio: 0.581 Non down regulation 149 (24.7%) 88 (26.6%) down regulation 454 (75.3%) 243 (73.4%) E2 on HCG day 4546 ± 2647 4672 ± 2950 0.517 P on HCG day 0.92 ± 0.71 1.04 ± 1.37 0.121 The days of Gn 10.7 ± 1.66 10.7 ± 1.69 0.925 Endometrial thickness 10.2 ± 2.45 10.2 ± 2.51 0.953 Transferred embryos types: 0.545 Fresh embryo transfer 358 (59.4%) 204 (61.6%) Frozen embryo transfer 245 (40.6%) 127 (38.4%) Transferred embryos numbers: 0.459 1 27 (4.48%) 21 (6.34%) 2 372 (61.7%) 202 (61.0%) 3 204 (33.8%) 108 (32.6%) Transferred embryos stage: 0.077 Cleavage stage embryo 495 (82.1%) 255 (77.0%) Blastula 108 (17.9%) 76 (23.0%) HCG at 14 days after embryo transfer 876 (824) 966 (889) 0.131 Intrauterine effusion: 1.000 No 572 (94.9%) 314 (94.9%) Yes 31 (5.14%) 17 (5.14%) Fibroid: 0.570 No 581 (96.4%) 322 (97.3%) Yes 22 (3.65%) 9 (2.72%) Endometrium deviation: 0.755 No 595 (98.7%) 328 (99.1%) Yes 8 (1.33%) 3 (0.91%) Status: 0.510 non-EP 444 (73.6%) 251 (75.8%) EP 159 (26.4%) 80 (24.2%) Abbreviation FSH: Follicle stimulating hormone HCG: Human chorionic gonadotropin Gn: gonadotropins EP: ectopic pregnancy E2: Estradiol P: Progesterone Factors associated with EP Univariate analyses revealed several factors, such as infertility factors (female pelvic and fallopian tube factors), number of pregnancies, EP numbers, treatment, conditions of fallopian tubes, history of pelvic and abdominal surgery, serum estradiol level on HCG day, endometrial thickness, transferred embryo types, numbers, and stage, and HCG at 14 days after embryo transfer, to be significantly associated with EP (Table 2 ). Univariate and multivariate logistic regression analyses were performed according to Table 3 . Multivariate logistic regression analysis showed that infertility factors (female pelvic and fallopian tube factors) (OR = 1.14, 95% CI 1.05–1.238, P = 0.002), previous EP (OR = 4.413, 95% CI 0.644–0.992, P = 0.042), high estrogen level (OR = 1, 95% CI 1–1, P = 0.002), FET (OR = 0.909, 95% CI 0.858–0.964, P = 0.001), and HCG 14 days after embryo transfer (OR = 1, 95%CI 1–1, P = 0.001) were independent risk factors for EP after embryo transfer (Table 3 ). Table 2 Comparison of Baseline characteristics in the training cohort Factors non-EP (N = 444) EP(N = 159) P- value Age(y) 30.8 ± 4.38 31.0 ± 4.10 0.782 BMI(kg/㎡) 22.7 ± 3.44 22.2 ± 3.17 0.085 FSH(µg/mL) 6.73 ± 2.59 6.79 ± 2.25 0.791 Infertility factors: <0.001 Others 73 (16.4%) 9 (5.66%) Male 28 (6.31%) 2 (1.26%) Female(Pelvic fallopian tube) 343 (77.3%) 148 (93.1%) Number of pregnancy: 0.037 No 189 (42.6%) 52 (32.7%) Yes 255 (57.4%) 107 (67.3%) Number of births: 0.563 One time 75 (16.9%) 29 (18.2%) Many times 9 (2.03%) 1 (0.63%) None 360 (81.1%) 129 (81.1%) Ectopic pregnancy numbers: <0.001 One time 41 (9.23%) 33 (20.8%) Many times 25 (5.63%) 22 (13.8%) None 378 (85.1%) 104 (65.4%) Treatment: <0.001 Medication 382 (86.0%) 108 (67.9%) Operation 62 (14.0%) 51 (32.1%) Cesarean section numbers: 0.529 No 411 (92.6%) 144 (90.6%) Yes 33 (7.43%) 15 (9.43%) Intrauterine factors: 0.489 Normal 311 (70.0%) 106 (66.7%) Abnormal 133 (30.0%) 53 (33.3%) Conditions of Fallopian tubes: 0.027 Others 46 (10.4%) 13 (8.18%) Bilateral obstruction 353 (79.5%) 140 (88.1%) Bilateral patency 45 (10.1%) 6 (3.77%) Mycoplasma: 0.366 No 376 (84.7%) 140 (88.1%) Yes 68 (15.3%) 19 (11.9%) History of pelvic and abdominal surgery: <0.001 No 255 (57.4%) 64 (40.3%) Yes 189 (42.6%) 95 (59.7%) Protocol of controlled ovarian hyperstimulatio: 0.146 Non down regulation 117 (26.4%) 32 (20.1%) down regulation 327 (73.6%) 127 (79.9%) E2 on HCG day 3930 [2395;6021] 4560 [2939;6486] 0.033 P on HCG day 0.70 [0.50;1.01] 0.80 [0.60;1.08] 0.076 The days of Gn 10.7 ± 1.68 10.9 ± 1.60 0.332 Endometrial thickness 10.0 [9.00;12.0] 9.00 [8.00;11.0] 0.001 Transferred embryos types : 0.037 Fresh embryo transfer 252 (56.8%) 106 (66.7%) Frozen embryo transfer 192 (43.2%) 53 (33.3%) Transferred embryos numbers: 0.029 1 24 (5.41%) 3 (1.89%) 2 281 (63.3%) 91 (57.2%) 3 139 (31.3%) 65 (40.9%) Transferred embryos stage: 0.016 Cleavage stage embryo 354 (79.7%) 141 (88.7%) Blastula 90 (20.3%) 18 (11.3%) HCG 14 days after embryo transfer 806 [499;1239] 307 [176;541] <0.001 Intrauterine effusion: 0.164 No 425 (95.7%) 147 (92.5%) Yes 19 (4.28%) 12 (7.55%) Fibroid: 1.000 No 428 (96.4%) 153 (96.2%) Yes 16 (3.60%) 6 (3.77%) Endometrium deviation: 0.688 No 437 (98.4%) 158 (99.4%) Yes 7 (1.58%) 1 (0.63%) Table 3 Multivariate logistic regression in the training cohort β wald OR (95%CI) P -value BMI 0.008 3.515 0.992(0.984 ~ 1) 0.061 Infertility factors(male) 0.073 1.09 1.075(0.938 ~ 1.233) 0.297 Infertility factors(female) 0.131 9.765 1.14(1.05 ~ 1.238) 0.002* Number of pregnancy(Yes) 0.009 0.094 0.991(0.934 ~ 1.051) 0.760 Ectopic pregnancy numbers(many times) 0.085 1.937 1.089(0.966 ~ 1.228) 0.164 Ectopic pregnancy numbers(none) 0.224 4.143 0.799(0.644 ~ 0.992) 0.042* Treatment(Operation) 0.097 0.749 0.907(0.728 ~ 1.131) 0.387 Conditions of Fallopian tubes(Bilateral obstruction) 0.012 0.055 1.012(0.919 ~ 1.114) 0.815 Conditions of Fallopian tubes(Bilateral patency) 0.039 0.426 0.962(0.857 ~ 1.081) 0.514 History of pelvic and abdominal surgery 0.001 0 1.001(0.942 ~ 1.062) 0.987 E2 on HCG day ＜0.001 9.618 1(1 ~ 1) 0.002* P on HCG day -0.02 2.082 0.98(0.954 ~ 1.007) 0.149 Endometrial thickness -0.01 3.133 0.99(0.98 ~ 1.001) 0.077 Transferred embryos types (Fresh embryo transfer) 0.095 10.233 0.909(0.858 ~ 0.964) 0.001* Transferred embryos numbers (2) 0.003 0.002 1.003(0.885 ~ 1.137) 0.964 Transferred embryos numbers: (3) 0.041 0.384 1.042(0.915 ~ 1.186) 0.536 Transferred embryos stage(Blastula) 0.032 0.732 0.968(0.899 ~ 1.043) 0.392 HCG at 14 days after embryo transfer ＜0.001 86.281 1(1 ~ 1) ＜0.001* Establishment and evaluation of the nomogram To predict the probability of EP, a nomogram was derived from multivariable logistic regression of the training cohort (Fig. 2 ). The results showed that HCG level 14 days after embryo transfer was the dominant factor in the nomogram model. According to the nomogram model, each predictor was assigned either a total score (bottom scale) or a weighted total score (top scale), indicating the probability of EP. Based on the training cohort, the C-index was 0.819 (95% CI 0.799–0.839), and in the validation cohort, it was 0.882 (95% CI 0.857–0.905), indicating reliable discrimination of the nomogram prediction model. In addition, calibration curves for the training cohort and validation cohort (Fig. 3 ) showed good concordance between the predicted and observed probabilities, suggesting effective calibration of the nomogram prediction model. Finally, the diagnostic accuracy of the nomogram prediction model was assessed. These analyses showed both high specificity and sensitivity in the training and validation cohorts (Fig. 4 ): AUC = 0.819, specificity = 78.0%, sensitivity = 73.9% for the training cohort; AUC = 0.882, specificity = 83.8%, sensitivity = 80.5% for the validation cohort. DISCUSSION As ART has become increasingly popular, related complications and long-term efficacy have become a concern for clinicians. The most common and severe IVF complication is EP, which is the leading cause of early maternal death. Individualized quantitative tools to predict the incidence of EP after IVF effectively and accurately are lacking. In this study, we found that infertility factors, previous ectopic pregnancy, high estrogen levels, FET, and low HCG levels at 14 days after embryo transfer were independent risk factors for EP. Based on internal and external validations, our prediction model has a good predictive performance. Several risk factors are associated with EP, such as infertility, previous pelvic infection, congenital anomalies of the uterine tubes, endometriosis, and previous EP. 5 Pelvic fallopian tube factors are recognized as high-risk factors that can lead to the development of EP. 6 Since the embryo is itinerant in the uterine cavity after transplantation, catheterization of the uterine cavity may stimulate the uterus to contract, causing the embryo that has just entered the uterine cavity to be squeezed and drift into the fallopian tube. EP occurs when the fallopian tubes are impaired in their original peristaltic transport function due to chronic inflammation, and the embryo cannot return to the uterine cavity before implantation. Jacob et al. 7 retrospectively analyzed the effect of a history of gynecologic surgery on EP and found that a history of ectopic pregnancy and genital surgery was closely associated with EP. Murtinger et al. 8 showed that a history of tubal surgery and previous EP significantly increases the incidence of EP. The results of this study are consistent with those of previous clinical studies. In this study, the number of previous EP in patients was classified as 0, 1, or multiple, and the results showed that 0 previous EP were a protective factor. However, there was no statistically significant difference in the number of EP between 1 and multiple pregnancies. It is also indicated that the incidence of EP after embryo transfer will increase once an EP has occurred. A case-control study reported that a previous history of EP was the most powerful risk factor linked to EP, and the incidence of EP did not increase with an increase in previous EP. 9 However, other studies could not prove an association between previous and subsequent EP. 10 Several studies have shown that high estrogen levels and an imbalance in the ratio of estrogen to progesterone can alter the homeostasis of the fallopian tubes and uterine cavity in the physiological state, and affect uterine contraction and endometrial tolerance, which contribute to EP after transplantation. 11–13 A retrospective cohort study of 103,070 embryo transfer cycles demonstrated that the incidence of EP after fresh embryo transfer was much higher than that after cryopreservation, mainly because of changes in the fallopian tube and uterine environment caused by high estrogen levels during the fresh embryo transfer cycle. 14 Our study also demonstrated that high estrogen levels are a risk factor for EP in the fresh embryonic cycle. With the development of embryo freezing technology, several studies have shown that compared to fresh embryo transfer, cryopreservation can significantly reduce the risk of EP. 15 This may be because the fresh embryo transfer cycle is stimulated using a large quantity of ovulation-stimulating drugs, which reduce the tolerance of the endometrium, causing the embryos placed in the uterine cavity to fail to implant and drift into the fallopian tubes. However, some studies have shown that there is no significant difference between the fresh embryo transfer cycle and the FET cycle. 16 However, in this study, fresh embryo transfer was a protective factor and FET was a risk factor for EP. This may be because all patients included in the FET cycle in this study used hormone replacement cycles to exclude possible differences in embryo transfer windows due to the different protocols. Establishment of this cycle requires the use of a large quantity of estrogen, and the commonly used estradiol valerate incremental method can result in an estradiol level of approximately 500 pg/ml on the day of transplantation. Since estradiol valerate cannot be used to construct the implantation intima, it is possible that the serum estradiol level can reach 2500 pg/ml on the day of transplantation by using estradiol preparations with a higher potency ratio, such as Femoston(2 mg estradiol/10 mg dydrogesterone, Abbott Laboratories, USA). This means that patients who prepare their endometrium with hormone replacement cycles have a highly estrogenic state in their bodies before and after transplantation. Therefore, whether FET is a risk factor for EP requires further confirmation by prospective studies. FET has the advantages of increasing the cumulative success rate of one cycle of oocyte retrieval, reducing the risk of multiple pregnancies with IVF, and reducing the incidence of ovarian hyperstimulation syndrome. 17 It was previously thought that in IUP, serum hCG levels rise by at least 66% at 48 h intervals. Kohn et al. 18 stated that HCG concentrations rising by less than 50% within 48 h is evidence of an inactive pregnancy and suggests EP. Souza et al. 19 found that EP was associated with progesterone levels of < 10 ng/mL and HCG levels of < 1500 IU/L. The results of this study showed that low HCG levels 14 days after embryo transfer were a risk factor for the development of EP. It has also been demonstrated that the lower the HCG rate of increase in early pregnancy, the higher the risk of adverse pregnancy outcomes. 20 Limitations In some fertility centers, embryos at the cleavage-stage are thawed one day earlier and then transferred the next day, which is equivalent to shortening the implantation time of embryos in the uterine cavity. In our center, frozen embryos are transferred on the day of thawing; therefore, the embryos take a little longer to develop to the blastocyst stage and implant than those thawed earlier, which may increase the probability of EP after transfer. In addition, this study was retrospective; therefore, there may be some uncertain confounding factors, and the data were obtained from a single medical center. Therefore, future randomized controlled trials and multicenter studies are required to confirm our findings. CONCLUSIONS In conclusion, this study suggests that infertility factors, previous ectopic pregnancy, high estrogen level, FET, and low HCG levels at 14 days after embryo transfer are independent risk factors for EP after ART. We constructed a novel prediction nomogram using a multivariate logistic regression analysis method, which can provide a quantitative and objective reference tool for directly evaluating the risk factors for the development of EP and help in clinical decision making prior to IVF-embryo transfer. Every embryo transfer is precious and minimizing the occurrence of EP is a common goal for every couple and clinician. Abbreviations EP ectopic pregnancy IVF-ET in vitro fertilization-embryo transfer ART assisted reproductive technology FET frozen-thawed embryo transfer ICSI intracytoplasmic sperm injection IUP intrauterine pregnancy HCG human chorionic gonadotropin ROC receiver operating characteristic Declarations Ethics approval and consent to participate This study was approved by our hospital’s ethics review board, and all patients provided written informed consent. Approval number of the IRB was 202012. Consent for publication Not applicable. Availability of data and materials The data that support the findings of this study are available from Xiangtan Central Hospital Reproductive Center but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of Xiangtan Central Hospital . Competing interests The authors declare that they have no conflict of interest. Funding No funds have been received for the development of this publication. Authors' contributions SH, SHC, BX, XHH and XJT designed the research. SH and BX wrote the manuscript. SHC, CL, JL, SQZ and XYC were involved in literature searches and data collection. XHH and XJT revised the manuscript and had all responsibility of this study. All authors read and approved the final manuscript. Acknowledgments We would like to thank Editage (www.editage.cn) for English language editing. References Creanga AA, Syverson C, Seed K, et al. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017;130(2):366–373. Jurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ 2011;342:d3397. Refaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015;13:30. Ankum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996 Jun;65(6):1093-1099. Daniel N, Bashir B, Ibrahim A, et al. A 26-year-old retained demised abdominal pregnancy presenting with umbilical fistula. Case Rep Obstet Gynecol 2014;2014:932525. Chang HJ, Suh CS. Ectopic pregnancy after assisted reproductive technology: what are the risk factors? Curr Opin Obstet Gynecol 2010;22(3):202–207. Jacob L, Kalder M, Kostev K. Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients. Ger Med Sci 2017;15:Doc19. Jwa S C, Seto S, Takamura M, et al. Ovarian stimulation increases the risk of ectopic pregnancy for fresh embryo transfers: an analysis of 68,851 clinical pregnancies from the Japanese Assisted Reproductive Technology registry. Fertil Steril 2020;114(6):1198–1206. Moini A, Hosseini R, Jahangiri N, et al. Risk factors for ectopic pregnancy: a case-control study. J Res Med Sci 2014;19:844–849. Malek-Mellouli M, Oumara M, Ben Amara F, et al. Prediction of ectopic pregnancy in early pregnancy of unknown location. Tunis Med 2013;91:27–32. Mueller A, Siemer J, Schreiner S, et al. Role of estrogen and progesterone in the regulation of uterine peristalsis: results from perfused non-pregnant swine uteri. Hum Reprod 2006;21(7):1863–1868. Fanchin R, Ayoubi JM, Olivennes F, et al. Hormonal influence on the uterine contractility during ovarian stimulation. Hum Reprod 2000;15(Suppl 1):90–100. Pal L, Jindal S, Witt BR, et al. Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization. Fertil Steril 2008;89(6):1694–1701. Keegan DA, Morelli SS, Noyes N, et al. Low ectopic pregnancy rates after in vitro fertilization: do practice habits matter?. Fertil Steril 2007;88(3):734–736. Jwa SC, Seto S, Takamura M, et al. Ovarian stimulation increases the risk of ectopic pregnancy for fresh embryo transfers: an analysis of 68,851 clinical pregnancies from the Japanese Assisted Reproductive Technology registry. Fertil Steril 2020;114(6):1198–1206. Imudia AN, Awonuga AO, Doyle JO, et al. Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization. Fertil Steril. 2012 Jun;97(6):1374-9. Grzegorczyk-Martin V, Mayenga JM, Kulski O, et al. Préparation endométriale chez les receveuses dans un programme de don d'ovocytes [Endometrial preparation in oocyte recipients]. Gynecol Obstet Fertil 2012;40(9):507–510. French. Kohn MA, Kerr K, Malkevich D, et al. Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding. Acad Emerg Med 2003;10(2):119–126. De Souza MJ, Toombs RJ, Scheid JL, et al. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod 2010;25(2):491–503. Visconti K, Zite N. hCG in ectopic pregnancy. Clin Obstet Gynecol. 2012 Jun;55(2):410-7. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3333439","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":236555868,"identity":"254b3dcf-a516-44cf-ab38-c5f74d75dc51","order_by":0,"name":"Sang He","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Sang","middleName":"","lastName":"He","suffix":""},{"id":236555869,"identity":"47f5be7a-ad2f-4a59-8326-d8aa277015da","order_by":1,"name":"Bing Xie","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bing","middleName":"","lastName":"Xie","suffix":""},{"id":236555870,"identity":"e84fe7d6-3d68-4781-a331-3dbfda379ed0","order_by":2,"name":"ShengHui Cao","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"ShengHui","middleName":"","lastName":"Cao","suffix":""},{"id":236555871,"identity":"9a4485c7-0449-4031-a938-21450a71ca14","order_by":3,"name":"Chen Luo","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chen","middleName":"","lastName":"Luo","suffix":""},{"id":236555872,"identity":"eb714229-c9e2-4ba4-b4cf-1c8c5a82c257","order_by":4,"name":"Jiao Lin","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jiao","middleName":"","lastName":"Lin","suffix":""},{"id":236555873,"identity":"588d098b-b6cd-465f-b7a1-d46e3f38e21c","order_by":5,"name":"ShunQiang Zhou","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"ShunQiang","middleName":"","lastName":"Zhou","suffix":""},{"id":236555874,"identity":"e2500705-5159-4ae8-a4ea-97949e70cfd8","order_by":6,"name":"XiaoYan Chen","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"XiaoYan","middleName":"","lastName":"Chen","suffix":""},{"id":236555875,"identity":"012dedb0-be9e-4501-af18-673749996aa9","order_by":7,"name":"XiangHong Huang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuklEQVRIie3QoQ7CMBCA4WuWFFPQpxiPUDIBvE1RM5slVRiSqgWNWOAt0G2WgCnTJBgSLGJykloE4XCIfvr+3LUAUfSHJAiwncYxH2wsOWFu5+fZSJwUOUmaodHLPRYTWjLD0oYEcwMFQK+P35NF1SpXt1gauFhW+RvhsHMl7XMVErZVCTOUpBHSCo45T4QkJmGLEwYV5+TEexk+GadGcOVob7kWWdfpdZoeHu7ea0Lyxv44H0VRFH3yApxxPr+2VLijAAAAAElFTkSuQmCC","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"XiangHong","middleName":"","lastName":"Huang","suffix":""},{"id":236555876,"identity":"4bdf007e-ddf6-4389-8fb1-96b1e231b73f","order_by":8,"name":"XiaoJun Tan","email":"","orcid":"","institution":"Xiangtan Central Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"XiaoJun","middleName":"","lastName":"Tan","suffix":""}],"badges":[],"createdAt":"2023-09-07 07:14:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3333439/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3333439/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":44095291,"identity":"d3f32310-05b7-4fe1-81da-4c6a75c57a57","added_by":"auto","created_at":"2023-10-04 16:59:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41889,"visible":true,"origin":"","legend":"\u003cp\u003eA flow chart selection\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-3333439/v1/a5714d0419e780aa20cf1248.png"},{"id":44093991,"identity":"280374ad-6085-464e-b5ce-85f0eade8d66","added_by":"auto","created_at":"2023-10-04 16:51:02","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":29624,"visible":true,"origin":"","legend":"\u003cp\u003eA nomogram was derived from multivariable logistic regression of the training cohort\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-3333439/v1/21b9d4ce0866e35312c5e04c.png"},{"id":44093989,"identity":"e50c387e-1377-4d44-b66b-8dbb8bbec8b4","added_by":"auto","created_at":"2023-10-04 16:51:01","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":63493,"visible":true,"origin":"","legend":"\u003cp\u003eThe calibration curves for the training cohort (A) and validation cohort (B)\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-3333439/v1/e1bc7106b3fb2b95257b746d.png"},{"id":44093988,"identity":"b37f7418-bdae-4ffc-a453-a67b9619df8e","added_by":"auto","created_at":"2023-10-04 16:51:01","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":71624,"visible":true,"origin":"","legend":"\u003cp\u003eThe receiver operating characteristic curves for the training cohort (A) and validation cohort (B)\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-3333439/v1/e4e767571f09fbac45b70ae0.png"},{"id":44096461,"identity":"90851449-21d6-415a-ae83-7055f079628a","added_by":"auto","created_at":"2023-10-04 17:07:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":583032,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3333439/v1/e252dab6-5959-4c05-9df6-624320634103.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Ectopic pregnancy following in vitro fertilization-embryo transfer: A retrospective diagnostic study to develop a predictive nomogram","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEctopic pregnancy (EP) is a common acute abdominal disease and one of the main causes of maternal death during the first trimester of pregnancy.\u003csup\u003e1\u003c/sup\u003e Approximately 1\u0026ndash;2% of spontaneous pregnancies are ectopic,\u003csup\u003e2\u003c/sup\u003e and with the increased use of assisted reproductive technology (ART), the incidence is rising to 2.1\u0026ndash;8.6%.\u003csup\u003e3\u003c/sup\u003e Failure of assisted pregnancy due to EP can cause stress in couples, especially if multiple treatment cycles are required.\u003c/p\u003e \u003cp\u003eHowever, the reasons for the increased risk of EP during in vitro fertilization (IVF) are not entirely known. Therefore, researchers are paying increasing attention to the high-risk factors for EP following IVF and investigating measures to reduce the risk of EP. A previous study revealed that EP may be influenced by a history of cesarean section, smoking, infertility, EP, and oral contraceptives.\u003csup\u003e4\u003c/sup\u003e Some studies have shown that the probability of EP varies between frozen-thawed embryo transfer (FET) and fresh embryo transfer, cleavage-stage embryo transfer, and blastocyst transfer.\u003csup\u003e3\u003c/sup\u003e Nevertheless, we still lack an intuitive EP risk prediction model that can provide recommendations for EP-risk patients. Therefore, the factors that can be used as risk factors for EP in assisted reproduction are still debated. It is also desirable to create a quantifiable model to predict the occurrence of EP.\u003c/p\u003e \u003cp\u003eTherefore, the aim of this study was to explore more sensitive risk factors for EP and to develop a predictive model for the potential risk of EP.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy designs and subjects\u003c/h2\u003e \u003cp\u003eThis retrospective analysis was conducted on couples who received IVF/ intracytoplasmic sperm injection (ICSI) treatment at the Reproductive Center of Xiangtan Central Hospital between January 2010 and December 2020. According to the principle of 1:3 random re-sampling, a total of 934 cases were divided into the EP group (N\u0026thinsp;=\u0026thinsp;239) and the intrauterine pregnancy (IUP) group (N\u0026thinsp;=\u0026thinsp;695). The exclusion criteria were: patients with failed transplantation, slow FET cycle, embryos transferred on day 2 or 4 or twice in the same cycle, or patients lost to follow-up after transplantation. A flow chart selection is given in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAll patients were treated using the conventional ovulation promotion protocol of our center. When two-thirds of major follicles reach an average diameter of 18 mm, human chorionic gonadotropin (HCG) is administered to trigger oocyte maturation. After 36 h, the oocytes were aspirated transvaginally under ultrasound guidance. Conventional IVF or ICSI was used depending on the semen quality. After in vitro culture for 3\u0026ndash;6 days, these embryos were transferred or frozen; frozen-thawed embryos were then transferred at the appropriate time. Hormone replacement cycles were used to prepare the endometrium during freeze-thaw cycles.\u003c/p\u003e \u003cp\u003eAfter embryo transfer, all patients received HCG injections or vaginal progesterone soft capsules (Besins Manufacturing Belgium, Spain, 100 mg) for luteal support. Serum HCG level was measured on day 14 following embryo transfer, and luteal support was continued in HCG-positive individuals. Clinical pregnancy was diagnosed by vaginal ultrasound 28 days after transplantation, when the gestational sac, yolk sac, and heartbeat were observed. EP was diagnosed if there were masses, cysts, or a fetal heartbeat outside the uterus.\u003c/p\u003e \u003cp\u003eDemographic data, history of risk factors, laboratory findings, and ultrasound findings were reviewed and recorded for a total of 22 factors. All factors were extracted and selected from a literature review to obtain the statistical significance related to our findings.\u003c/p\u003e \u003cp\u003e This study was approved by the Ethics Committee of Xiangtan Central Hospital, and all patients provided written informed consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eDatasets were divided in a 65:35 ratio into training and validation cohorts. Training cohorts were used to build models, and validation cohorts were used to validate the models. Statistical analysis was performed using R software version 3.6.3, using either the chi-square test for counting data, or a non-parametric test for measurement or grade data. Risk factors related to EP were analyzed using univariate logistic regression followed by multivariate logistic regression. The coefficients of the factors selected by multivariate logistic regression were used to develop a nomogram prediction model. The statistical significance of the difference was determined as P\u0026thinsp;\u0026lt;\u0026thinsp;0.05. Based on the concordance (C)-index, the discrimination ability of the models was evaluated. A C-index (0.5\u0026thinsp;\u0026le;\u0026thinsp;C-index\u0026thinsp;\u0026le;\u0026thinsp;1) of 0.5 suggests no predictive discrimination, while an index of 1.0 indicates perfect discrimination. Calibration curves were used to estimate the calibration efficiency of the model. A calibration curve was constructed to evaluate the consistency between the predicted and observed probabilities. The 45\u0026deg; line represents the best prediction, and coincidence represents a better prediction. Finally, diagnostic analysis was performed using receiver operating characteristic (ROC) curves. The area under the curve (AUC) of the ROC curves represents the prediction accuracy of our nomogram prediction model, where an AUC value of 0.5, represents a matter of chance, while an AUC value of 1 indicates perfect accuracy.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePatients\u0026rsquo; characteristics\u003c/h2\u003e \u003cp\u003eIn total, 934 patients were included in this study. Random sampling of the patient group was used to separate them into training (N\u0026thinsp;=\u0026thinsp;603) and validation cohorts (N\u0026thinsp;=\u0026thinsp;331). Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows the training and validation sets were comparable.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBaseline characteristics in the training and validation cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraining cohort (N\u0026thinsp;=\u0026thinsp;603)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eValidation cohort(N\u0026thinsp;=\u0026thinsp;331 )\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.9\u0026thinsp;\u0026plusmn;\u0026thinsp;4.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.239\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/㎡)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.6\u0026thinsp;\u0026plusmn;\u0026thinsp;3.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSH(\u0026micro;g/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.74\u0026thinsp;\u0026plusmn;\u0026thinsp;2.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.75\u0026thinsp;\u0026plusmn;\u0026thinsp;2.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.990\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility factors:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e82 (13.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (15.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30 (4.98%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (5.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale(Pelvic fallopian tube)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e491 (81.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e263 (79.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pregnancy:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e241 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e133 (40.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e362 (60.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e198 (59.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of births:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e104 (17.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMany times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 (1.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (1.81%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e489 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e266 (80.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy numbers:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e74 (12.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (14.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMany times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (7.79%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (6.04%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e482 (79.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e262 (79.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.982\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e490 (81.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e268 (81.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113 (18.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (19.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section numbers:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.441\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e555 (92.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e299 (90.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48 (7.96%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (9.67%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine factors:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e417 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e229 (69.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e186 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e102 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditions\u0026nbsp;of\u0026nbsp;Fallopian\u0026nbsp;tubes:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.155\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e59 (9.78%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36 (10.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e493 (81.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (77.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral patency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e51 (8.46%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (12.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMycoplasma:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.442\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e516 (85.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e290 (87.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e87 (14.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (12.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of pelvic and abdominal surgery:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e319 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e175 (52.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e284 (47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156 (47.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtocol of controlled ovarian hyperstimulatio:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.581\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon down regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e149 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88 (26.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edown regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e454 (75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e243 (73.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 on HCG day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4546\u0026thinsp;\u0026plusmn;\u0026thinsp;2647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4672\u0026thinsp;\u0026plusmn;\u0026thinsp;2950\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP on HCG day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.92\u0026thinsp;\u0026plusmn;\u0026thinsp;0.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.04\u0026thinsp;\u0026plusmn;\u0026thinsp;1.37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.121\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe days of Gn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.925\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.2\u0026thinsp;\u0026plusmn;\u0026thinsp;2.51\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos types:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e358 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204 (61.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrozen embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e245 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (38.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos numbers:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.459\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27 (4.48%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (6.34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e372 (61.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e202 (61.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e204 (33.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (32.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos stage:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleavage stage embryo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e495 (82.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e255 (77.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlastula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e108 (17.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (23.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCG at 14 days after embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e876 (824)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e966 (889)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine effusion:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e572 (94.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e314 (94.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (5.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (5.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibroid:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e581 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e322 (97.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22 (3.65%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.72%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrium deviation:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.755\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e595 (98.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e328 (99.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (1.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStatus:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.510\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003enon-EP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e444 (73.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e251 (75.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e159 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (24.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAbbreviation\u003c/b\u003e FSH: Follicle stimulating hormone HCG: Human chorionic gonadotropin Gn: gonadotropins EP: ectopic pregnancy E2: Estradiol P: Progesterone\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with EP\u003c/h2\u003e \u003cp\u003eUnivariate analyses revealed several factors, such as infertility factors (female pelvic and fallopian tube factors), number of pregnancies, EP numbers, treatment, conditions of fallopian tubes, history of pelvic and abdominal surgery, serum estradiol level on HCG day, endometrial thickness, transferred embryo types, numbers, and stage, and HCG at 14 days after embryo transfer, to be significantly associated with EP (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Univariate and multivariate logistic regression analyses were performed according to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Multivariate logistic regression analysis showed that infertility factors (female pelvic and fallopian tube factors) (OR\u0026thinsp;=\u0026thinsp;1.14, 95% CI 1.05\u0026ndash;1.238, P\u0026thinsp;=\u0026thinsp;0.002), previous EP (OR\u0026thinsp;=\u0026thinsp;4.413, 95% CI 0.644\u0026ndash;0.992, P\u0026thinsp;=\u0026thinsp;0.042), high estrogen level (OR\u0026thinsp;=\u0026thinsp;1, 95% CI 1\u0026ndash;1, P\u0026thinsp;=\u0026thinsp;0.002), FET (OR\u0026thinsp;=\u0026thinsp;0.909, 95% CI 0.858\u0026ndash;0.964, P\u0026thinsp;=\u0026thinsp;0.001), and HCG 14 days after embryo transfer (OR\u0026thinsp;=\u0026thinsp;1, 95%CI 1\u0026ndash;1, P\u0026thinsp;=\u0026thinsp;0.001) were independent risk factors for EP after embryo transfer (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison of Baseline characteristics in the training cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003enon-EP (N\u0026thinsp;=\u0026thinsp;444)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEP(N\u0026thinsp;=\u0026thinsp;159)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP-\u003c/em\u003evalue\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(y)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e30.8\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.0\u0026thinsp;\u0026plusmn;\u0026thinsp;4.10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.782\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI(kg/㎡)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.2\u0026thinsp;\u0026plusmn;\u0026thinsp;3.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFSH(\u0026micro;g/mL)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6.73\u0026thinsp;\u0026plusmn;\u0026thinsp;2.59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.79\u0026thinsp;\u0026plusmn;\u0026thinsp;2.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.791\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility factors:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (16.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (5.66%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (6.31%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (1.26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale(Pelvic fallopian tube)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e343 (77.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e148 (93.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pregnancy:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189 (42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (32.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e255 (57.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (67.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of births:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.563\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e75 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (18.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMany times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (2.03%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e360 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e129 (81.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy numbers:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (9.23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMany times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (5.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e378 (85.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104 (65.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e382 (86.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e108 (67.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62 (14.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e51 (32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section numbers:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e411 (92.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e144 (90.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33 (7.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (9.43%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine factors:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.489\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e311 (70.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbnormal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e133 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditions of Fallopian tubes:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.027\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (8.18%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral obstruction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e353 (79.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (88.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBilateral patency\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45 (10.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (3.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMycoplasma:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e376 (84.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e140 (88.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68 (15.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (11.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of pelvic and abdominal surgery:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e255 (57.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (40.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189 (42.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (59.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtocol of controlled ovarian hyperstimulatio:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.146\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNon down regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e117 (26.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (20.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edown regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e327 (73.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e127 (79.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 on HCG day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3930 [2395;6021]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4560 [2939;6486]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.033\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP on HCG day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.70 [0.50;1.01]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.80 [0.60;1.08]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.076\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe days of Gn\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.7\u0026thinsp;\u0026plusmn;\u0026thinsp;1.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.9\u0026thinsp;\u0026plusmn;\u0026thinsp;1.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.332\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.0 [9.00;12.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.00 [8.00;11.0]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos types :\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.037\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFresh embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252 (56.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrozen embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e192 (43.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos numbers:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.029\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 (5.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e281 (63.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91 (57.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e139 (31.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65 (40.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos stage:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCleavage stage embryo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e354 (79.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e141 (88.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlastula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (20.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (11.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCG 14 days after embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e806 [499;1239]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e307 [176;541]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntrauterine effusion:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e425 (95.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e147 (92.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (4.28%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (7.55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibroid:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e428 (96.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153 (96.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (3.60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (3.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrium deviation:\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e437 (98.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e158 (99.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (1.58%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.63%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate logistic regression in the training cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ewald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.515\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.992(0.984\u0026thinsp;~\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.061\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility factors(male)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.075(0.938\u0026thinsp;~\u0026thinsp;1.233)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.297\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfertility factors(female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.14(1.05\u0026thinsp;~\u0026thinsp;1.238)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of pregnancy(Yes)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.991(0.934\u0026thinsp;~\u0026thinsp;1.051)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy numbers(many times)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.937\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.089(0.966\u0026thinsp;~\u0026thinsp;1.228)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEctopic pregnancy numbers(none)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.799(0.644\u0026thinsp;~\u0026thinsp;0.992)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.042*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTreatment(Operation)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.097\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.749\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.907(0.728\u0026thinsp;~\u0026thinsp;1.131)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditions of Fallopian tubes(Bilateral obstruction)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.012(0.919\u0026thinsp;~\u0026thinsp;1.114)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConditions of Fallopian tubes(Bilateral patency)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.962(0.857\u0026thinsp;~\u0026thinsp;1.081)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.514\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHistory of pelvic and abdominal surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.001(0.942\u0026thinsp;~\u0026thinsp;1.062)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eE2 on HCG day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＜0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.618\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1\u0026thinsp;~\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP on HCG day\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.98(0.954\u0026thinsp;~\u0026thinsp;1.007)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.149\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndometrial thickness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.99(0.98\u0026thinsp;~\u0026thinsp;1.001)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.077\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos types (Fresh embryo transfer)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.909(0.858\u0026thinsp;~\u0026thinsp;0.964)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos numbers (2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.003(0.885\u0026thinsp;~\u0026thinsp;1.137)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.964\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos numbers: (3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.041\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.042(0.915\u0026thinsp;~\u0026thinsp;1.186)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.536\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferred embryos stage(Blastula)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.732\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.968(0.899\u0026thinsp;~\u0026thinsp;1.043)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.392\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHCG at 14 days after embryo transfer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e＜0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.281\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(1\u0026thinsp;~\u0026thinsp;1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e＜0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eEstablishment and evaluation of the nomogram\u003c/h2\u003e \u003cp\u003eTo predict the probability of EP, a nomogram was derived from multivariable logistic regression of the training cohort (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). The results showed that HCG level 14 days after embryo transfer was the dominant factor in the nomogram model. According to the nomogram model, each predictor was assigned either a total score (bottom scale) or a weighted total score (top scale), indicating the probability of EP.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eBased on the training cohort, the C-index was 0.819 (95% CI 0.799\u0026ndash;0.839), and in the validation cohort, it was 0.882 (95% CI 0.857\u0026ndash;0.905), indicating reliable discrimination of the nomogram prediction model. In addition, calibration curves for the training cohort and validation cohort (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) showed good concordance between the predicted and observed probabilities, suggesting effective calibration of the nomogram prediction model.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFinally, the diagnostic accuracy of the nomogram prediction model was assessed. These analyses showed both high specificity and sensitivity in the training and validation cohorts (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e): AUC\u0026thinsp;=\u0026thinsp;0.819, specificity\u0026thinsp;=\u0026thinsp;78.0%, sensitivity\u0026thinsp;=\u0026thinsp;73.9% for the training cohort; AUC\u0026thinsp;=\u0026thinsp;0.882, specificity\u0026thinsp;=\u0026thinsp;83.8%, sensitivity\u0026thinsp;=\u0026thinsp;80.5% for the validation cohort.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAs ART has become increasingly popular, related complications and long-term efficacy have become a concern for clinicians. The most common and severe IVF complication is EP, which is the leading cause of early maternal death. Individualized quantitative tools to predict the incidence of EP after IVF effectively and accurately are lacking. In this study, we found that infertility factors, previous ectopic pregnancy, high estrogen levels, FET, and low HCG levels at 14 days after embryo transfer were independent risk factors for EP. Based on internal and external validations, our prediction model has a good predictive performance.\u003c/p\u003e \u003cp\u003eSeveral risk factors are associated with EP, such as infertility, previous pelvic infection, congenital anomalies of the uterine tubes, endometriosis, and previous EP.\u003csup\u003e5\u003c/sup\u003e Pelvic fallopian tube factors are recognized as high-risk factors that can lead to the development of EP.\u003csup\u003e6\u003c/sup\u003e Since the embryo is itinerant in the uterine cavity after transplantation, catheterization of the uterine cavity may stimulate the uterus to contract, causing the embryo that has just entered the uterine cavity to be squeezed and drift into the fallopian tube. EP occurs when the fallopian tubes are impaired in their original peristaltic transport function due to chronic inflammation, and the embryo cannot return to the uterine cavity before implantation. Jacob et al.\u003csup\u003e7\u003c/sup\u003e retrospectively analyzed the effect of a history of gynecologic surgery on EP and found that a history of ectopic pregnancy and genital surgery was closely associated with EP. Murtinger et al.\u003csup\u003e8\u003c/sup\u003e showed that a history of tubal surgery and previous EP significantly increases the incidence of EP. The results of this study are consistent with those of previous clinical studies.\u003c/p\u003e \u003cp\u003eIn this study, the number of previous EP in patients was classified as 0, 1, or multiple, and the results showed that 0 previous EP were a protective factor. However, there was no statistically significant difference in the number of EP between 1 and multiple pregnancies. It is also indicated that the incidence of EP after embryo transfer will increase once an EP has occurred. A case-control study reported that a previous history of EP was the most powerful risk factor linked to EP, and the incidence of EP did not increase with an increase in previous EP.\u003csup\u003e9\u003c/sup\u003e However, other studies could not prove an association between previous and subsequent EP.\u003csup\u003e10\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eSeveral studies have shown that high estrogen levels and an imbalance in the ratio of estrogen to progesterone can alter the homeostasis of the fallopian tubes and uterine cavity in the physiological state, and affect uterine contraction and endometrial tolerance, which contribute to EP after transplantation.\u003csup\u003e11\u0026ndash;13\u003c/sup\u003e A retrospective cohort study of 103,070 embryo transfer cycles demonstrated that the incidence of EP after fresh embryo transfer was much higher than that after cryopreservation, mainly because of changes in the fallopian tube and uterine environment caused by high estrogen levels during the fresh embryo transfer cycle.\u003csup\u003e14\u003c/sup\u003e Our study also demonstrated that high estrogen levels are a risk factor for EP in the fresh embryonic cycle.\u003c/p\u003e \u003cp\u003eWith the development of embryo freezing technology, several studies have shown that compared to fresh embryo transfer, cryopreservation can significantly reduce the risk of EP.\u003csup\u003e15\u003c/sup\u003e This may be because the fresh embryo transfer cycle is stimulated using a large quantity of ovulation-stimulating drugs, which reduce the tolerance of the endometrium, causing the embryos placed in the uterine cavity to fail to implant and drift into the fallopian tubes. However, some studies have shown that there is no significant difference between the fresh embryo transfer cycle and the FET cycle.\u003csup\u003e16\u003c/sup\u003e However, in this study, fresh embryo transfer was a protective factor and FET was a risk factor for EP. This may be because all patients included in the FET cycle in this study used hormone replacement cycles to exclude possible differences in embryo transfer windows due to the different protocols. Establishment of this cycle requires the use of a large quantity of estrogen, and the commonly used estradiol valerate incremental method can result in an estradiol level of approximately 500 pg/ml on the day of transplantation. Since estradiol valerate cannot be used to construct the implantation intima, it is possible that the serum estradiol level can reach 2500 pg/ml on the day of transplantation by using estradiol preparations with a higher potency ratio, such as Femoston(2 mg estradiol/10 mg dydrogesterone, Abbott Laboratories, USA). This means that patients who prepare their endometrium with hormone replacement cycles have a highly estrogenic state in their bodies before and after transplantation. Therefore, whether FET is a risk factor for EP requires further confirmation by prospective studies. FET has the advantages of increasing the cumulative success rate of one cycle of oocyte retrieval, reducing the risk of multiple pregnancies with IVF, and reducing the incidence of ovarian hyperstimulation syndrome.\u003csup\u003e17\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIt was previously thought that in IUP, serum hCG levels rise by at least 66% at 48 h intervals. Kohn et al.\u003csup\u003e18\u003c/sup\u003e stated that HCG concentrations rising by less than 50% within 48 h is evidence of an inactive pregnancy and suggests EP. Souza et al.\u003csup\u003e19\u003c/sup\u003e found that EP was associated with progesterone levels of \u0026lt;\u0026thinsp;10 ng/mL and HCG levels of \u0026lt;\u0026thinsp;1500 IU/L. The results of this study showed that low HCG levels 14 days after embryo transfer were a risk factor for the development of EP. It has also been demonstrated that the lower the HCG rate of increase in early pregnancy, the higher the risk of adverse pregnancy outcomes.\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e"},{"header":"Limitations","content":"\u003cp\u003eIn some fertility centers, embryos at the cleavage-stage are thawed one day earlier and then transferred the next day, which is equivalent to shortening the implantation time of embryos in the uterine cavity. In our center, frozen embryos are transferred on the day of thawing; therefore, the embryos take a little longer to develop to the blastocyst stage and implant than those thawed earlier, which may increase the probability of EP after transfer. In addition, this study was retrospective; therefore, there may be some uncertain confounding factors, and the data were obtained from a single medical center. Therefore, future randomized controlled trials and multicenter studies are required to confirm our findings.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion, this study suggests that infertility factors, previous ectopic pregnancy, high estrogen level, FET, and low HCG levels at 14 days after embryo transfer are independent risk factors for EP after ART. We constructed a novel prediction nomogram using a multivariate logistic regression analysis method, which can provide a quantitative and objective reference tool for directly evaluating the risk factors for the development of EP and help in clinical decision making prior to IVF-embryo transfer. Every embryo transfer is precious and minimizing the occurrence of EP is a common goal for every couple and clinician.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eEP \u0026nbsp; ectopic pregnancy\u003c/p\u003e\n\u003cp\u003eIVF-ET \u0026nbsp;in vitro fertilization-embryo transfer\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eART \u0026nbsp;assisted reproductive technology\u003c/p\u003e\n\u003cp\u003eFET \u0026nbsp;frozen-thawed embryo transfer\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eICSI \u0026nbsp;intracytoplasmic sperm injection\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIUP \u0026nbsp;intrauterine pregnancy\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHCG \u0026nbsp;human chorionic gonadotropin\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eROC \u0026nbsp;receiver operating characteristic\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by our hospital\u0026rsquo;s ethics review board, and all patients provided written informed consent. Approval number of the IRB was 202012.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from Xiangtan Central Hospital Reproductive Center but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of \u0026nbsp;Xiangtan Central Hospital .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funds have been received for the development of this publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSH, SHC, BX, XHH and XJT designed the research. SH and BX wrote the manuscript. SHC, CL, JL, SQZ and XYC were involved in literature searches and\u0026nbsp;\u003c/p\u003e\n\u003cp\u003edata collection. XHH and XJT revised the manuscript and had all responsibility of this study. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe would like to thank Editage (www.editage.cn) for English language editing.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCreanga AA, Syverson C, Seed K, et al. Pregnancy-related mortality in the United States, 2011-2013. Obstet Gynecol 2017;130(2):366\u0026ndash;373. \u003c/li\u003e\n\u003cli\u003eJurkovic D, Wilkinson H. Diagnosis and management of ectopic pregnancy. BMJ 2011;342:d3397.\u003c/li\u003e\n\u003cli\u003eRefaat B, Dalton E, Ledger WL. Ectopic pregnancy secondary to in vitro fertilisation-embryo transfer: pathogenic mechanisms and management strategies. Reprod Biol Endocrinol 2015;13:30.\u003c/li\u003e\n\u003cli\u003eAnkum WM, Mol BW, Van der Veen F, Bossuyt PM. Risk factors for ectopic pregnancy: a meta-analysis. Fertil Steril. 1996 Jun;65(6):1093-1099. \u003c/li\u003e\n\u003cli\u003eDaniel N, Bashir B, Ibrahim A, et al. A 26-year-old retained demised abdominal pregnancy presenting with umbilical fistula. Case Rep Obstet Gynecol 2014;2014:932525.\u003c/li\u003e\n\u003cli\u003eChang HJ, Suh CS. Ectopic pregnancy after assisted reproductive technology: what are the risk factors? Curr Opin Obstet Gynecol 2010;22(3):202\u0026ndash;207.\u003c/li\u003e\n\u003cli\u003eJacob L, Kalder M, Kostev K. Risk factors for ectopic pregnancy in Germany: a retrospective study of 100,197 patients. Ger Med Sci 2017;15:Doc19.\u003c/li\u003e\n\u003cli\u003eJwa S C, Seto S, Takamura M, et al. Ovarian stimulation increases the risk of ectopic pregnancy for fresh embryo transfers: an analysis of 68,851 clinical pregnancies from the Japanese Assisted Reproductive Technology registry. Fertil Steril 2020;114(6):1198\u0026ndash;1206.\u003c/li\u003e\n\u003cli\u003eMoini A, Hosseini R, Jahangiri N, et al. Risk factors for ectopic pregnancy: a case-control study. J Res Med Sci 2014;19:844\u0026ndash;849.\u003c/li\u003e\n\u003cli\u003eMalek-Mellouli M, Oumara M, Ben Amara F, et al. Prediction of ectopic pregnancy in early pregnancy of unknown location. Tunis Med 2013;91:27\u0026ndash;32.\u003c/li\u003e\n\u003cli\u003eMueller A, Siemer J, Schreiner S, et al. Role of estrogen and progesterone in the regulation of uterine peristalsis: results from perfused non-pregnant swine uteri. Hum Reprod 2006;21(7):1863\u0026ndash;1868.\u003c/li\u003e\n\u003cli\u003eFanchin R, Ayoubi JM, Olivennes F, et al. Hormonal influence on the uterine contractility during ovarian stimulation. Hum Reprod 2000;15(Suppl 1):90\u0026ndash;100.\u003c/li\u003e\n\u003cli\u003ePal L, Jindal S, Witt BR, et al. Less is more: increased gonadotropin use for ovarian stimulation adversely influences clinical pregnancy and live birth after in vitro fertilization. Fertil Steril 2008;89(6):1694\u0026ndash;1701.\u003c/li\u003e\n\u003cli\u003eKeegan DA, Morelli SS, Noyes N, et al. Low ectopic pregnancy rates after in vitro fertilization: do practice habits matter?. Fertil Steril 2007;88(3):734\u0026ndash;736.\u003c/li\u003e\n\u003cli\u003eJwa SC, Seto S, Takamura M, et al. Ovarian stimulation increases the risk of ectopic pregnancy for fresh embryo transfers: an analysis of 68,851 clinical pregnancies from the Japanese Assisted Reproductive Technology registry. Fertil Steril 2020;114(6):1198\u0026ndash;1206.\u003c/li\u003e\n\u003cli\u003eImudia AN, Awonuga AO, Doyle JO, et al. Peak serum estradiol level during controlled ovarian hyperstimulation is associated with increased risk of small for gestational age and preeclampsia in singleton pregnancies after in vitro fertilization. Fertil Steril. 2012 Jun;97(6):1374-9.\u003c/li\u003e\n\u003cli\u003eGrzegorczyk-Martin V, Mayenga JM, Kulski O, et al. Pr\u0026eacute;paration endom\u0026eacute;triale chez les receveuses dans un programme de don d\u0026apos;ovocytes [Endometrial preparation in oocyte recipients]. Gynecol Obstet Fertil 2012;40(9):507\u0026ndash;510. French.\u003c/li\u003e\n\u003cli\u003eKohn MA, Kerr K, Malkevich D, et al. Beta-human chorionic gonadotropin levels and the likelihood of ectopic pregnancy in emergency department patients with abdominal pain or vaginal bleeding. Acad Emerg Med 2003;10(2):119\u0026ndash;126.\u003c/li\u003e\n\u003cli\u003eDe Souza MJ, Toombs RJ, Scheid JL, et al. High prevalence of subtle and severe menstrual disturbances in exercising women: confirmation using daily hormone measures. Hum Reprod 2010;25(2):491\u0026ndash;503.\u003c/li\u003e\n\u003cli\u003eVisconti K, Zite N. hCG in ectopic pregnancy. Clin Obstet Gynecol. 2012 Jun;55(2):410-7. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"ectopic pregnancy, in vitro fertilization-embryo transfer, risk factors, nomogram","lastPublishedDoi":"10.21203/rs.3.rs-3333439/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3333439/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the risk factors associated with ectopic pregnancy (EP) following in vitro fertilization-embryo transfer (IVF-ET) to establish a model to predict the risk of EP.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective cohort study was conducted in our hospital between January 2010 and December 2020. The enrolled dataset was randomly divided into two: a training cohort (65%, N\u0026thinsp;=\u0026thinsp;603) and validation cohort (35%, N\u0026thinsp;=\u0026thinsp;331). Clinical characteristics and laboratory indexes were associated with EP following IVF-ET based on univariate and multivariate analyses, and nomograms for predicting EP were established. Discrimination and calibration were assessed using the concordance (C)-index and a calibration curve.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMultivariate logistic regression analysis showed that female factors, previous ectopic pregnancy, high estrogen levels, frozen-thawed embryo transfer, and low human chorionic gonadotropin levels at 14 days post embryo transfer were risk factors for EP. Multivariate logistic regression analysis was used to develop the nomogram. A C-index of 0.819 and 0.882 in the training and validation cohorts respectively, indicated the model had reliable discrimination, and the calibration plot overlapped the diagonal reference line of perfect calibration, indicating effective calibration.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eWe developed and validated a nomogram for predicting the probability of EP that provides clinicians with a quantitative tool.\u003c/p\u003e","manuscriptTitle":"Ectopic pregnancy following in vitro fertilization-embryo transfer: A retrospective diagnostic study to develop a predictive nomogram","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-10-04 16:50:57","doi":"10.21203/rs.3.rs-3333439/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-04-28T10:10:32+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"25ffd182-bb21-4ad1-95e5-843fa7bae1b1","date":"2024-04-16T00:52:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"68b09d49-74c9-45c0-81d1-bdc1f0b057f4_SNPRID","date":"2024-04-15T12:35:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-14T16:40:52+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-04-09T10:32:18+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46a27928-48e3-4e7c-aa53-1d836d6affa3","date":"2024-04-05T08:51:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"4c2501e7-50da-4da5-9ca0-a22c64dc5a27","date":"2024-03-25T02:47:46+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2023-11-30T13:57:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2023-11-30T11:22:12+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2023-09-28T03:42:34+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2023-09-28T03:40:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2023-09-07T07:12:52+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"52ce5d43-2324-440a-8661-ba31fd9c7c7f","owner":[],"postedDate":"October 4th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-09-06T04:42:24+00:00","versionOfRecord":[],"versionCreatedAt":"2023-10-04 16:50:57","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3333439","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3333439","identity":"rs-3333439","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}