Multifactor Prediction of Embryo Transfer Outcomes Based on a Machine Learning Algorithm

In vitro fertilization-embryo transfer (IVF-ET) technology make it possible for infertile couples to conceive a baby successfully. Nevertheless, IVF-ET does not guarantee success. Frozen embryo transfer (FET) is an important supplement to IVF-ET. Many factors are correlated with the outcome of FET which is unpredictable. Machine learning is a field of study that predict various outcomes by defining data attributes and using relevant data and calculation algorithms. Machine learning algorithm has been widely used in clinical research. The present study focuses on making predictions of early pregnancy outcomes in FET through clinical characters, including age, body mass index (BMI), endometrial thickness (EMT) on the day of progesterone treatment, good-quality embryo rate (GQR), and type of infertility (primary or secondary), serum estradiol level (E2) on the day of embryo transfer, and serum progesterone level (P) on the day of embryo transfer. We applied four representative machine learning algorithms, including logistic regression (LR), conditional inference tree, random forest (RF) and support vector machine (SVM) to build prediction models and identify the predictive factors. We found no significant difference among the models in the sensitivity, specificity, positive predictive rate, negative predictive rate or accuracy in predicting the pregnancy outcome of FET. For example, the positive/negative predictive rate of the SVM (gamma = 1, cost = 100, 10-fold cross validation) is 0.56 and 0.55. This approach could provide a reference for couples considering FET. The prediction accuracy of the present study is limited, which suggests that there may be some other more effective predictors to be developed in future work.

Impact of Plasmatic Progesterone on the Day of Frozen Embryo Transfer in Hormone-induced Cycles

Objective To establish a relationship between serum progesterone values on the day of frozen blastocyst transfer in hormone-replaced cycles with the probability of pregnancy, miscarriage or delivery. Methods This was an ambispective observational study including all frozen-thawed embryo transfer cycles performed at our department following in vitro fecundation from May 2018 to June 2019. The outcomes evaluated were β human chorionic gonadotropin (β-hCG)-positive pregnancy and delivery. Groups were compared according to the level of serum progesterone on the day of embryo transfer: the 1st quartile of progesterone was compared against the other quartiles and then the 2nd and 3rd quartiles against the 4th quartile. Results A total of 140 transfers were included in the analysis: 87 with β-HCG > 10 IU/L (62%), of which 50 (36%) delivered and 37 had a miscarriage (42%). Women with lower progesterone levels (< 10.7ng/mL) had a trend toward higher β-HCG-positive (72 versus 59%; p > 0.05), lower delivery (26 versus 39%; p > 0.05) and higher miscarriage rates (64 versus 33%; p < 0.01). Comparing the middle quartiles (P25–50) with those above percentiles 75, the rate of pregnancy was similar (60 versus 57%; p > 0.05), although there was a trend toward a higher number of deliveries (43 versus 31%; p > 0.05) and a lower number of miscarriages (28 versus 45%; p > 0.05). These differences were not statistically significant. Conclusion There were no differences in pregnancy and delivery rates related with the progesterone level when measured in the transfer day. The miscarriage rate was higher in the 1st quartile group.

P–286 Uterine vascularity in women with previous caesarean section and its potential role in implantation failure: a retrospective cohort study

Study question Does a previous Caesarean section affect uterine vascularisation the day of embryo transfer? Summary answer 3D vascularisation parameters show less uterine irrigation in patients with previous Caesarean section What is known already A recent retrospective cohort study demonstrates that previous Caesarean section impairs live birth rates after assisted reproductive treatment (ART) compared to a previous vaginal delivery. Furthermore, it has been hypothesized about the mechanisms by which post-cesarean section niche may diminish clinical pregnancy rates. One of the hypothetical process mentioned has been a distorted contractility of the uterus caused by fibrosis, which can influence in the vascularisation of the endometrium. Study design, size, duration We retrospectively studied the uterine contractility and 3D vascularisation parameters in women who had an embryo transfer at the Instituto Bernabeu of Alicante, between 2018 and 2020 with one recurrent implantation failure (at least two good quality blastocysts transferred from egg donation treatment). Participants/materials, setting, methods Patients with large myomas (more than 4 cm), adenomyosis or polyp were excluded. In total, 196 patients were assessed on the day of embryo transfer which 12 patients had a previous caesarean section. Uterine contractility was analyzed using 4D ultrasound after 6 minutes of video recording. Vascularisation index and vascularisation flow index were assessed after the endometrial volume definition. Main results and the role of chance Baseline characteristics of both groups were comparable. 3D vascularization parameters were significantly lower in women with a previous caesarean section. Vascularization Index (VI) reached 0,8% in caesarean section group (CS group) versus 2,3% (p = 0,038) and vascularization flow index (VFI) was 0,2 in CS group versus 0,8 (p = 0,038) Despite uterine peristalsis showed less contractility in those patients with previous caesarean section (0,8 contractions per minute versus 1,1 contractions per minute), non-statistical differences were demonstrated (p = 0,154) Limitations, reasons for caution This study is limited by its retrospective design and the low number of cases. Wider implications of the findings: The lower 3D vascularisation indexes support a post-Caesarean section vascular-related impaired perfusion as a hypothetical mechanism. Its correlation with a possible impairment in the embryo implantation after fertility treatments warrants further studies. Trial registration number Not applicable

O-200 Frozen embryo transfer: Miscarriage rates depending on the starting day of intramuscular progesterone

Study question Objective was to assess whether adjusting starting day of intramuscular progesterone the day of vaginal supplementation versus day of embryo transfer or later, might affect the outcome of the cycle. Summary answer additional injection of intramuscular progesterone the day of progesterone initiation or later, is not likely to be more effective on live birth and miscarriage rates. What is known already There is no consensus on the most effective method of endometrium preparation prior to FET. However, many studies report that high serum progesterone concentration during the implantation period is associated with optimal live birth rates. Adjusting progesterone treatment the day of embryo transfer seems to be too late and ineffective for rescuing low progesterone levels and should be done before. Study design, size, duration In this single center prospective study from October 2019 to november 2020, 239 patients undergoing hormonal replacement therapy protocol for frozen embryo transfer were randomly divided into two groups: additional injection of intramuscular progesterone the day of progesterone initiation or intramuscular progesterone the day of embryo transfer. We compare these results to our previous protocol beginning intramuscular progesterone day 22 of the treatment. Participants/materials, setting, methods Our frozen embryo transfer protocol consists to initiate GnRH agonist the day 1 of the cycle. After 14 days of estrogens, we introduce vaginal progesterone, prior to embryo transfer. Patients in group A received an additional injection of intramuscular progesterone the day of progesterone initiation. The group B received intramuscular progesterone the day of embryo transfer. For both, intramuscular injection of progesterone was followed every 3 days. Main results and the role of chance 239 patients were enrolled in this study, 125 in the group A and 114 in the group B. The ongoing pregnancy rate in the group A was 26.4 % and miscarriage rate 7.2%, not statistically different from ongoing pregnancy rate and miscarriage rate of women in the group B (22.81 %, p = 0.66/ 6.14%, p = 0.8). The ongoing pregnancy rate in the group D22 was 24.89 % et miscarriage rate 7.2%, not statistically different from ongoing pregnancy rate of women in the group A and B (p = 0.78 and p = 0.31). Limitations, reasons for caution The main limitation of our study is the lack of randomization for the group with additional progesterone IM on day 22. The study is actually followed to enroll more patients in 3 different groups. Wider implications of the findings This study tries to determine optimal adaptive management of hormonal replacement treatment for embryo transfer in patients with potential low progesterone values. Trial registration number no applicable