由欧洲人类生殖和胚胎学学会定义的反复植入失败的风险因素
Can Wang1,2, Youhui Lu1,2, Miaoxian Ou1,2
1Department of Obstetrics and Gynecology, Reproductive Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Human reproduction (Oxford, England)
|March 27, 2025
概括
抗穆勒尔激素 (AMH) 是复发性植入失败 (RIF) 的最强有力的预测因素. 其他关键因素包括慢性子宫内膜炎 (CE),子宫内粘附和BMI,突出了改善生育治疗策略的领域.
科学领域:
- 生殖医学 生殖医学
- 不孕症研究 不孕症研究
- 医学诊断 医学诊断 医学诊断
背景情况:
- 复发性植入失败 (RIF) 是辅助生殖技术 (ART) 的一个重大挑战.
- 虽然母亲的晚年是已知的危险因素,但其他因素如慢性子宫内膜炎 (CE),子宫内膜异位症,BMI和子宫内粘附需要进一步调查.
- 这些因素在预测RIF中的相对重要性尚不清楚.
研究的目的:
- 根据ESHRE的建议,识别和对复发性植入失败 (RIF) 未被认可的风险因素进行排名.
- 使用机器学习开发和验证RIF的预测模型.
主要方法:
- 一项回顾性队列研究分析了2019年6月至2022年6月期间的15329次ART周期.
- 收集了298名RIF患者和2056名对照者的数据,包括临床,实验室和成像结果.
- 采用随机森林模型来预测RIF,并使用SHAP值进行解释.
主要成果:
- 抗穆勒尔激素 (AMH) 的升高和活产史与较低的RIF风险有关.
- 慢性子宫内膜炎 (CE),子宫内粘附,高FSH,高丸激素,晚年,多,重复流产,剖腹产史,多囊性卵巢综合症和类风湿性疾病增加了RIF风险.
- 预测模型的AUC为0.83 (训练) 和0.78 (测试),AMH被确定为最强的预测因子,其次是CE,子宫内粘附和BMI.
结论:
- 亚美是RIF最重要的预测因素,超过了年龄等传统因素.
- 在RIF预测中,CE,子宫内粘附和BMI也是关键因素.
- 识别和解决这些因素可能会提高ART的成功率,并减少怀孕所需的周期数量.
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