Construction of A Nomogram Model for Predicting Pregnancy Outcomes in Fresh Embryo Transfer Cycles Using GnRH Antagonist Protocols

doi:10.12280/gjszjk.20260383

Abstract

Abstract:

Objective: To investigate the factors influencing the clinical pregnancy rate in fresh embryo transfer cycles using gonadotropin-releasing hormone (GnRH) antagonist protocols, and to construct and validate a predictive model. Methods: A total of 2 405 fresh embryo transfer cycles using GnRH antagonist protocols were retrospectively analyzed, at the Third Affiliated Hospital of Sun Yat-Sen University between January 2018 and December 2024. The cycles were randomly allocated into a training cohort (n=1 683) and a validation cohort (n=722) at a 7∶3 ratio. The independent factors influencing clinical pregnancy were identified by multivariate logistic regression analysis, which were subsequently used to construct a nomogram. The model performance was then evaluated using the area under the receiver operating characteristic curve and calibration curves. Results: Multivariable logistic regression analysis revealed that a greater number of high-quality D3 embryos (OR=0.88, 95%CI: 0.82-0.94) and the transfer of two embryos (versus one embryo, OR=0.52, 95%CI: 0.37-0.72) were associated with decreased probability of non-clinical pregnancy. Conversely, the advancing female age (OR=1.04, 95%CI: 1.00-1.09) and the elevated serum progesterone on trigger-day (OR=2.44, 95%CI: 1.46-4.09) were associated with increased probability of non-clinical pregnancy. Based on these four independent predictors, a predictive model for clinical pregnancy was developed, and a nomogram was constructed. The model was demonstrated the moderate discriminative performance, with an area under the receiver operating characteristic curve of 0.64 (95%CI: 0.61-0.67) in the training set and 0.65 (95%CI: 0.61-0.69) in the validation set. Calibration curves for both datasets showed a close agreement between predicted and observed probabilities, indicating good model calibration. Conclusions: The developed nomogram demonstrates favorable predictive performance, which may be used for the individualized prediction of clinical pregnancy, thereby providing data-driven recommendations for embryo transfer strategies.

Key words: Reproductive techniques, assisted, Embryo transfer, Gonadotropin-releasing hormone, Pregnancy outcome, Nomograms, GnRH antagonist protocol

LI Xin-xin, HUANG Yu-shan, GAN Tian, MENG Yue. Construction of A Nomogram Model for Predicting Pregnancy Outcomes in Fresh Embryo Transfer Cycles Using GnRH Antagonist Protocols[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(5): 368-372.

Figures/Tables 6

References 14

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指标	训练集（n=1 683）	验证集（n=722）	t或Z或χ²	P
女方年龄（岁）	33.19±5.09	33.41±5.36	0.925	0.355
男方年龄（岁）	35.10±5.85	35.38±6.09	1.060	0.289
BMI（kg/m²）	21.83±3.02	21.99±2.99	1.187	0.235
不孕时间（年）	3.00（2.00，5.00）	3.00（2.00，5.00）	-1.149	0.251
基础FSH（U/L）	7.33±2.72	7.30±2.44	-0.250	0.802
基础LH（U/L）	4.79±2.68	4.70±2.45	-0.790	0.429
基础E₂（pg/mL）	40.46±20.28	41.02±21.32	0.609	0.543
AMH（ng/mL）	2.42（1.25，4.27）	2.38（1.25，4.13）	-0.501	0.617
AFC（枚）	11.39±5.69	11.22±5.65	-0.655	0.512
Gn用量（IU）	1 947.82±581.29	1 984.33±595.31	1.402	0.161
Gn时间（d）	8.80±1.32	8.84±1.37	0.594	0.553
扳机日E₂（pg/mL）	1 975.49±951.39	1 958.84±931.94	-0.396	0.692
扳机日LH（IU/L）	3.29±2.71	3.28±2.50	-0.149	0.882
扳机日孕酮（ng/mL）	0.58±0.30	0.59±0.30	0.788	0.431
扳机日子宫内膜厚度（mm）	10.77±1.87	10.70±1.91	-0.789	0.430
获卵数（枚）	8.00（5.00，12.00）	9.00（5.00，12.00）	-0.244	0.807
正常受精数（枚）	5.00（3.00，8.00）	5.00（3.00，8.00）	-1.014	0.311
D3优质胚胎数（枚）	2.00（1.00，4.00）	2.00（1.00，4.00）	-1.310	0.190
受精方式			0.017	0.895
IVF	1 327（78.85）	571（79.09）
ICSI	356（21.15）	151（20.91）
移植胚胎阶段			0.557	0.455
D3	1 327（78.85）	579（80.19）
D5	356（21.15）	143（19.81）
移植胚胎数（枚）			0.036	0.849
1	669（39.75）	290（40.17）
2	1 014（60.25）	432（59.83）
临床妊娠率	763（45.34）	321（44.46）	0.157	0.692

指标	训练集（n=1 683）	验证集（n=722）	t或Z或χ²	P
女方年龄（岁）	33.19±5.09	33.41±5.36	0.925	0.355
男方年龄（岁）	35.10±5.85	35.38±6.09	1.060	0.289
BMI（kg/m²）	21.83±3.02	21.99±2.99	1.187	0.235
不孕时间（年）	3.00（2.00，5.00）	3.00（2.00，5.00）	-1.149	0.251
基础FSH（U/L）	7.33±2.72	7.30±2.44	-0.250	0.802
基础LH（U/L）	4.79±2.68	4.70±2.45	-0.790	0.429
基础E₂（pg/mL）	40.46±20.28	41.02±21.32	0.609	0.543
AMH（ng/mL）	2.42（1.25，4.27）	2.38（1.25，4.13）	-0.501	0.617
AFC（枚）	11.39±5.69	11.22±5.65	-0.655	0.512
Gn用量（IU）	1 947.82±581.29	1 984.33±595.31	1.402	0.161
Gn时间（d）	8.80±1.32	8.84±1.37	0.594	0.553
扳机日E₂（pg/mL）	1 975.49±951.39	1 958.84±931.94	-0.396	0.692
扳机日LH（IU/L）	3.29±2.71	3.28±2.50	-0.149	0.882
扳机日孕酮（ng/mL）	0.58±0.30	0.59±0.30	0.788	0.431
扳机日子宫内膜厚度（mm）	10.77±1.87	10.70±1.91	-0.789	0.430
获卵数（枚）	8.00（5.00，12.00）	9.00（5.00，12.00）	-0.244	0.807
正常受精数（枚）	5.00（3.00，8.00）	5.00（3.00，8.00）	-1.014	0.311
D3优质胚胎数（枚）	2.00（1.00，4.00）	2.00（1.00，4.00）	-1.310	0.190
受精方式			0.017	0.895
IVF	1 327（78.85）	571（79.09）
ICSI	356（21.15）	151（20.91）
移植胚胎阶段			0.557	0.455
D3	1 327（78.85）	579（80.19）
D5	356（21.15）	143（19.81）
移植胚胎数（枚）			0.036	0.849
1	669（39.75）	290（40.17）
2	1 014（60.25）	432（59.83）
临床妊娠率	763（45.34）	321（44.46）	0.157	0.692

指标	B	SE	Wald χ²	P	OR（95%CI）
女方年龄（岁）	0.043	0.020	4.565	0.033	1.04（1.00~1.09）
男方年龄（岁）	0.013	0.016	0.720	0.396	1.01（0.98~1.05）
BMI（kg/m²）	-0.011	0.024	0.232	0.630	0.99（0.94~1.04）
不孕时间（年）	0.032	0.023	1.861	0.173	1.03（0.99~1.08）
基础FSH（IU/L）	0.012	0.031	0.142	0.706	1.01（0.95~1.07）
基础LH（IU/L）	0.002	0.031	0.007	0.935	1.00（0.94~1.07）
基础E₂（pg/mL）	0.000	0.003	0.006	0.940	1.00（0.99~1.01）
AMH（ng/mL）	-0.030	0.035	0.763	0.382	0.97（0.91~1.04）
AFC（枚）	-0.004	0.018	0.062	0.804	1.00（0.96~1.03）
Gn用量（IU）	0.000	0.000	0.114	0.735	1.00（1.00~1.00）
Gn时间（d）	-0.096	0.067	2.091	0.148	0.91（0.80~1.04）
扳机日E₂（pg/mL）	0.000	0.000	0.018	0.893	1.00（1.00~1.00）
扳机日LH（IU/L）	-0.015	0.026	0.352	0.553	0.99（0.94~1.04）
扳机日孕酮（ng/mL）	0.893	0.263	11.512	0.001	2.44（1.46~4.09）
扳机日子宫内膜厚度（mm）	-0.028	0.034	0.692	0.405	0.97（0.91~1.04）
获卵数（枚）	0.040	0.030	1.800	0.180	1.04（0.98~1.11）
正常受精数（枚）	-0.052	0.038	1.922	0.166	0.95（0.88~1.02）
D3优质胚胎数（枚）	-0.132	0.036	13.446	0.000	0.88（0.82~0.94）
受精方式
IVF					1.00（Reference）
ICSI	0.219	0.156	1.958	0.162	1.24（0.92~1.69）
移植胚胎阶段
D3					1.00（Reference）
D5	-0.360	0.214	2.844	0.092	0.70（0.46~1.06）
移植胚胎数（枚）
1					1.00（Reference）
2	-0.659	0.168	15.407	0.000	0.52（0.37~0.72）

指标	B	SE	Wald χ²	P	OR（95%CI）
女方年龄（岁）	0.043	0.020	4.565	0.033	1.04（1.00~1.09）
男方年龄（岁）	0.013	0.016	0.720	0.396	1.01（0.98~1.05）
BMI（kg/m²）	-0.011	0.024	0.232	0.630	0.99（0.94~1.04）
不孕时间（年）	0.032	0.023	1.861	0.173	1.03（0.99~1.08）
基础FSH（IU/L）	0.012	0.031	0.142	0.706	1.01（0.95~1.07）
基础LH（IU/L）	0.002	0.031	0.007	0.935	1.00（0.94~1.07）
基础E₂（pg/mL）	0.000	0.003	0.006	0.940	1.00（0.99~1.01）
AMH（ng/mL）	-0.030	0.035	0.763	0.382	0.97（0.91~1.04）
AFC（枚）	-0.004	0.018	0.062	0.804	1.00（0.96~1.03）
Gn用量（IU）	0.000	0.000	0.114	0.735	1.00（1.00~1.00）
Gn时间（d）	-0.096	0.067	2.091	0.148	0.91（0.80~1.04）
扳机日E₂（pg/mL）	0.000	0.000	0.018	0.893	1.00（1.00~1.00）
扳机日LH（IU/L）	-0.015	0.026	0.352	0.553	0.99（0.94~1.04）
扳机日孕酮（ng/mL）	0.893	0.263	11.512	0.001	2.44（1.46~4.09）
扳机日子宫内膜厚度（mm）	-0.028	0.034	0.692	0.405	0.97（0.91~1.04）
获卵数（枚）	0.040	0.030	1.800	0.180	1.04（0.98~1.11）
正常受精数（枚）	-0.052	0.038	1.922	0.166	0.95（0.88~1.02）
D3优质胚胎数（枚）	-0.132	0.036	13.446	0.000	0.88（0.82~0.94）
受精方式
IVF					1.00（Reference）
ICSI	0.219	0.156	1.958	0.162	1.24（0.92~1.69）
移植胚胎阶段
D3					1.00（Reference）
D5	-0.360	0.214	2.844	0.092	0.70（0.46~1.06）
移植胚胎数（枚）
1					1.00（Reference）
2	-0.659	0.168	15.407	0.000	0.52（0.37~0.72）

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