Development and validation of a nomogram model for predicting clinical pregnancy in endometriosis patients undergoing fresh embryo transfer

Suqin Zhu, Xiuhua Liao, Wenwen Jiang, Yan Sun, Xiaojing Chen, Beihong Zheng
BMC pregnancy and childbirth · 2023 · vol. 23(1) , pp. 764 · doi:10.1186/s12884-023-06082-7 · PMID:37907870 · PMC10617063 · W4388047139
article OA: gold CC0 ⤵ 2 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-07 ⓘ

This study developed and validated a nomogram using age, endometriosis stage, time since surgery, AFC, AMH, GnRH agonist protocol, oocytes retrieved, high-quality embryos, and embryos transferred to predict clinical pregnancy in endometriosis patients undergoing fresh embryo transfer.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-07 ⓘ

This retrospective study developed and internally validated a nomogram to predict clinical pregnancy in 1630 women with surgically diagnosed endometriosis undergoing IVF with fresh embryo transfer at a single center (2018–2022), randomly split into model (n=1141) and validation (n=489) groups. Independent predictors of clinical pregnancy were selected using univariate analysis plus LASSO, then modeled with multifactorial forward stepwise logistic regression, and performance was assessed with ROC curves, calibration, and clinical decision curve analysis. The final model included female age, ASRM stage, postoperative-to-IVF duration, an ovarian stimulation GnRH agonist protocol, antral follicle count, AMH, number of oocytes retrieved, number of high-quality cleavage embryos, and number of embryos transferred, with discrimination around AUC ~0.807 in the model group and ~0.800 in validation, and no significant calibration difference by Hosmer-Lemeshow test. The main limitation explicitly stated is that adenomyosis cases with severe involvement and other complex comorbid conditions were excluded, limiting generalizability beyond this selected population. This paper is centrally about endometriosis—predicting clinical pregnancy outcomes after fresh embryo transfer using a validated nomogram.

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Abstract

PURPOSE: To construct and validate a nomogram model for predicting clinical pregnancy in individuals with endometriosis undergoing fersh embryo transfer (ET). METHODS: A retrospective analysis was conducted on 1630 individuals with endometriosis who underwent in vitro fertilization (IVF) with fresh embryo transfer at the Reproductive Medicine Center of Fujian Maternity and Child Health Hospital from January 2018 to January 2022. The research population was sorted into two groups through random sampling, namely, the model group (n = 1141) and the validation group (n = 489), with a ratio of 7:3. Univariate analysis was utilized to determine the influencing factors for clinical pregnancy in the model group. The LASSO algorithm was utilized to select the optimal matching factors, which were then included in a multifactorial forward stepwise logistic regression to determine independent influencing factors and develop a nomogram. The discrimination, accuracy, and clinical efficacy of the prediction model were analyzed utilizing the receiver operating characteristic (ROC) curve, calibration curve, and clinical decision curve. RESULTS: Through multivariate-logistic-regression analysis, these factors were identified as independent influencing factors for the clinical pregnancy in endometriosis patients undergoing fresh embryo transfer: female age (OR = 0.933, 95% CI = 0.902-0.965, P < 0.001), ASRM stage (OR = 0.384, 95% CI = 0.276-0.532, P < 0.001), postoperative to IVF duration (OR = 0.496, 95% CI = 0.356-0.688, P < 0.001), antral follicle count (AFC) (OR = 1.076, 95% CI = 1.013-1.161, P = 0.045), anti-Müllerian hormone (AMH) (OR = 1.202, 95% CI = 1.073-1.35, P = 0.002), Gonadotrophin-releasing hormone (GnRH) agonist protocol (OR = 1.536, 95% CI = 1.109-2.131, P = 0.01), number of oocytes retrieved (OR = 1.154, 95% CI = 1.067-1.249, P < 0.001), number of high-quality cleavage embryos (OR = 1.261, 95% CI = 1.164-1.369, P < 0.001), and number of embryos transferred (OR = 1.957, 95% CI = 1.435-2.679, P < 0.001). A prediction model for estimating the clinical pregnancy probability in individuals with endometriosis was constructed per these identified independent factors. The ROC showed an area under the curve (AUC) of 0.807 (95% CI = 0.782-0.832) in the model group and 0.800 (95% CI = 0.761-0.84) in the validation group. The Hosmer-Lemeshow test demonstrated no statistically significant difference between predicted and actual clinical pregnancy probabilities (P > 0.05). The clinical decision curve demonstrated that both the model and the validation groups achieved maximum net benefit at threshold probability values of 0.08-0.96 and 0.16-0.96, indicating good clinical efficacy within this range of threshold probabilities. CONCLUSION: Female age, ASRM stage, postoperative to IVF duration, stimulation protocol, AFC, AMH, number of oocytes retrieved, number of high-quality cleavage embryos and number of transferred embryos are independent influencing factors for the clinical pregnancy rate in individuals with endometriosis receiving fresh embryo transfer. The nomogram model based on these factors demonstrates good clinical predictive value and efficacy, providing a basis for clinical prognosis, intervention, and individualized medical treatment planning.

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Condition tags

endometriosis

MeSH descriptors

Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Endometriosis Child Child Child Child Child Child Child Child Child Embryo Transfer Embryo Transfer

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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