Comparison of Machine Learning model with Cox regression for prediction of cumulative live birth rate after assisted reproductive techniques: An internal and external validation

Predictive model for live birth outcomes in single euploid frozen embryo transfers: a comparative analysis of logistic regression and machine learning approaches

PURPOSE

To develop and validate a predictive model for live birth (LB) outcomes in single euploid frozen embryo transfers (seFET) based on patient's characteristics and embryo parameters.

METHODS

A retrospective cohort study was performed including 1979 seFET performed between March 2017 and December 2023. Prediction models were built using logistic regression (LR), random forest classifier (RFC), support vector machines (SVM), and a gradient booster (XGBoost). Considered variables associated with LB outcomes were blastocyst expansion, blastocyst inner cell mass (ICM) and TE quality, day (D) of TE biopsy (D5, D6, and D7), female age and body mass index (BMI), distance from the uterine fundus at embryo transfer, endometrial preparation as natural cycles (NC) or hormonal replacement therapy (HRT), and endometrial thickness. Model performance was evaluated using area under the precision-recall curve and calibration metrics.

RESULTS

Variables that were negatively associated with LB rate were BMI (OR = 0.79 [0.64-0.96], P = 0.020 for overweight and OR = 0.76 [0.60-0.95], P = 0.015 for obese class I/II), ICM grade B (OR = 0.72 [0.57-0.90], P = 0.005) or C (OR = 0.21 [0.15-0.30], P < 0.001), TE grade C (OR = 0.32 [0.24-0.43], P < 0.001), and blastocyst biopsied on D6 (OR = 0.66 [0.55-0.80], P < 0.001 or D7 (OR = 0.19[0.09-0.37], P < 0.001). The LR model was the best in terms of overall classification performance (C-statistics: 0.626 ± 0.018 vs. 0.606 ± 0.018, 0.581 ± 0.018, 0.601 ± 0.017, LR vs. RFC, XGBoost, and SVM, respectively, P < 0.001). A prediction model of LB outcome was developed and is free to access: https://artfertilityclinics.shinyapps.io/ABLE/ .

CONCLUSION

LR demonstrated a stable validation performance and superior LB prediction, aiding as a predictive tool for patient counselling and assessing success in seFET cycles.

Artificial Intelligence, Clinical Decision Support Algorithms, Mathematical Models, Calculators Applications in Infertility: Systematic Review and Hands-On Digital Applications

The aim of this systematic review was to identify clinical decision support algorithms (CDSAs) proposed for assisted reproductive technologies (ARTs) and to evaluate their effectiveness in improving ART cycles at every stage vs traditional methods, thereby providing an evidence-based guidance for their use in ART practice. A literature search on PubMed and Embase of articles published between 1 January 2013 and 31 January 2024 was performed to identify relevant articles. Prospective and retrospective studies in English on the use of CDSA for ART were included. Out of 1746 articles screened, 116 met the inclusion criteria. The selected articles were categorized into 3 areas: prognosis and patient counseling, clinical management, and embryo assessment. After screening, 11 CDSAs were identified as potentially valuable for clinical management and laboratory practices. Our findings highlight the potential of automated decision aids to improve in vitro fertilization outcomes. However, the main limitation of this review was the lack of standardization in validation methods across studies. Further validation and clinical trials are needed to establish the effectiveness of these tools in the clinical setting.

Factors affecting biochemical pregnancy loss (BPL) in preimplantation genetic testing for aneuploidy (PGT-A) cycles: machine learning-assisted identification

PURPOSE

To determine the factors influencing the likelihood of biochemical pregnancy loss (BPL) after transfer of a euploid embryo from preimplantation genetic testing for aneuploidy (PGT-A) cycles.

METHODS

The study employed an observational, retrospective cohort design, encompassing 6020 embryos from 2879 PGT-A cycles conducted between February 2013 and September 2021. Trophectoderm biopsies in day 5 (D5) or day 6 (D6) blastocysts were analyzed by next generation sequencing (NGS). Only single embryo transfers (SET) were considered, totaling 1161 transfers. Of these, 49.9% resulted in positive pregnancy tests, with 18.3% experiencing BPL. To establish a predictive model for BPL, both classical statistical methods and five different supervised classification machine learning algorithms were used. A total of forty-seven factors were incorporated as predictor variables in the machine learning models.

RESULTS

Throughout the optimization process for each model, various performance metrics were computed. Random Forest model emerged as the best model, boasting the highest area under the ROC curve (AUC) value of 0.913, alongside an accuracy of 0.830, positive predictive value of 0.857, and negative predictive value of 0.807. For the selected model, SHAP (SHapley Additive exPlanations) values were determined for each of the variables to establish which had the best predictive ability. Notably, variables pertaining to embryo biopsy demonstrated the greatest predictive capacity, followed by factors associated with ovarian stimulation (COS), maternal age, and paternal age.

CONCLUSIONS

The Random Forest model had a higher predictive power for identifying BPL occurrences in PGT-A cycles. Specifically, variables associated with the embryo biopsy procedure (biopsy day, number of biopsied embryos, and number of biopsied cells) and ovarian stimulation (number of oocytes retrieved and duration of stimulation), exhibited the strongest predictive power.

Immunological parameters of maternal peripheral blood as predictors of future pregnancy outcomes in patients with unexplained recurrent pregnancy loss

INTRODUCTION

Unexplained recurrent pregnancy loss (URPL), affecting approximately 1%-5% of women, exhibits a strong association with various maternal factors, particularly immune disorders. However, accurately predicting pregnancy outcomes based on the complex interactions and synergistic effects of various immune parameters without an automated algorithm remains challenging.

MATERIAL AND METHODS

In this historical cohort study, we analyzed the medical records of URPL patients treated at Xiangya Hospital, Changsha, China, between January 2020 and October 2022. The primary outcomes included clinical pregnancy and miscarriage. Predictors included complement, autoantibodies, peripheral lymphocytes, immunoglobulins, thromboelastography findings, and serum lipids. Least absolute shrinkage and selection operator (LASSO) analysis and logistic regression analysis was performed for model development. The model's performance, discriminatory, and clinical applicability were assessed using area under the curve (AUC), calibration curve, and decision curve analysis, respectively. Additionally, models were visualized by constructing dynamic and static nomograms.

RESULTS

In total, 502 patients with URPL were enrolled, of whom 291 (58%) achieved clinical pregnancy and 211 (42%) experienced miscarriage. Notable differences in complement, peripheral lymphocytes, and serum lipids were observed between the two outcome groups. Moreover, URPL patients with elevated peripheral NK cells (absolute counts and proportion), decreased complement levels, and dyslipidemia demonstrated a significantly increased risk of miscarriage. Four models were developed in this study, of which Model 2 demonstrated superior performance with only seven predictors, achieving an AUC of 0.96 (95% CI: 0.93-0.99) and an accuracy of 0.92. A web-based platform was established to visually present model 2 and to facilitate its utilization by clinicians in outpatient settings (available from: https://yingrongli.shinyapps.io/liyingrong/).

CONCLUSIONS

Our findings suggest that the implementation of such prediction models could serve as valuable tools for providing comprehensive information and facilitating clinicians in their decision-making processes.