Purpose

To develop and validate a prediction score for having 2 or more embryos cryopreserved following an IVF cycle without a fresh transfer such that an embryo selection method may be applicable. We also developed a counseling tool on the probability of not having any embryos following an IVF cycle without a fresh transfer.

Methods

We split the data into a development set and a validation set by region within the USA using a coin flip approach and subsequently performed a logistic regression model to identify factors most predictive of cryopreservation of 2 or more embryos in the development set. This model was validated in the validation set. Subsequently, a clinical prediction score was derived using the model coefficients and the predictive accuracy measured with the concordance (c) statistic.

Results

A total of 31,537 potential freeze-all cycles were reported to the Society for Assisted Reproductive Technology in 2014. Of these, 57.87% produced and cryopreserved two or more embryos. We identified that age, AMH, and the number of eggs retrieved were the most significant predictors of having 2 or more embryos cryopreserved with a validated c-statistic of 0.84 (95% CI: 0.83 to 0.85). A clinical prediction score was derived from the model. 28.9% of freeze-all cycles had no embryos created from the IVF cycle despite a cycle start and an egg retrieval. The number of eggs retrieved was the most significant predictor of having no embryos available for a transfer, with a c-statistic of 0.80 when modeled as the only predictor variable.

Conclusion

We derived counseling tools with acceptable discrimination for use in clinical practice (c-statistics > 0.7). Our study further suggests that the number of eggs retrieved from an IVF cycle is most predictive of having 2 or more embryos cryopreserved and not having any embryos after an IVF cycle, suggesting that clinicians should strive to optimize oocyte yield especially in poor prognosis patients. The probability of having two more embryos cryopreserved in a freeze-all IVF cycle such that an embryo selection method is applicable can be predicted with acceptable precision prior to the IVF cycle and excellent precision following egg retrieval using the prediction score.

中文翻译：

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在冷冻所有 IVF 周期后有两个或更多胚胎进行冷冻保存的经过验证的预测分数：利用 SART CORS 数据库的分析

目的

开发和验证在体外受精周期后冷冻保存 2 个或更多胚胎而无需新鲜移植的预测分数，以便胚胎选择方法可能适用。我们还开发了一种咨询工具，用于评估在未进行新移植的情况下在体外受精周期后没有任何胚胎的可能性。

方法

我们使用硬币翻转方法将数据按美国地区划分为开发集和验证集，随后执行逻辑回归模型以确定最能预测开发集中 2 个或更多胚胎冷冻保存的因素。该模型在验证集中得到验证。随后，使用模型系数和使用一致性 (c) 统计量测量的预测准确性得出临床预测分数。

结果

2014 年，向辅助生殖技术协会报告了总共 31,537 个潜在的全冷冻周期。其中，57.87% 生产并冷冻保存了两个或更多胚胎。我们确定年龄、AMH 和取回的卵子数量是冷冻保存 2 个或更多胚胎的最重要预测因素，经验证的 c 统计量为 0.84（95% CI：0.83 至 0.85）。临床预测评分来自该模型。尽管周期开始和取卵，但 28.9% 的全冷冻周期没有从 IVF 周期产生胚胎。取回的卵子数量是没有可用于移植的胚胎的最重要预测因子，当建模为唯一的预测变量时，c 统计量为 0.80。

结论

我们获得了可用于临床实践的具有可接受歧视的咨询工具（c-统计> 0.7）。我们的研究进一步表明，从 IVF 周期中取出的卵子数量最能预测有 2 个或更多胚胎冷冻保存，并且在 IVF 周期后没有任何胚胎，这表明临床医生应努力优化卵母细胞产量，尤其是在预后不良的患者中。在全冷冻 IVF 周期中冷冻保存两个胚胎以使胚胎选择方法适用的概率可以在 IVF 周期之前以可接受的精度进行预测，并使用预测分数在取卵后以极好的精度进行预测。