Can Ratios Between Prognostic Factors Predict the Clinical Pregnancy Rate in an IVF/ICSI Program with a GnRH Agonist-FSH
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INFERTILITY: ORIGINAL ARTICLE
Can Ratios Between Prognostic Factors Predict the Clinical Pregnancy Rate in an IVF/ICSI Program with a GnRH Agonist-FSH/hMG Protocol? An Assessment of 2421 Embryo Transfers, and a Review of the Literature Philippe Merviel 1,2 & Michel Menard 1 & Rosalie Cabry 3 & Florence Scheffler 3 & Emmanuelle Lourdel 3 & Marie-Thérèse Le Martelot 1 & Sylvie Roche 1 & Jean-Jacques Chabaud 1 & Henri Copin 3 & Hortense Drapier 1 & Moncef Benkhalifa 3 & Damien Beauvillard 1 Received: 28 May 2020 / Accepted: 25 August 2020 # Society for Reproductive Investigation 2020
Abstract None of the models developed in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) is sufficiently good predictors of pregnancy. The aim of this study was to determine whether ratios between prognostic factors could predict the clinical pregnancy rate in IVF/ICSI. We analyzed IVF/ICSI cycles (based on long GnRH agonist—FSH protocols) at two ART centers (the second to validate externally the data). The ratios studied were (i) the total FSH dose divided by the serum estradiol level on the hCG trigger day, (ii) the total FSH dose divided by the number of mature oocytes, (iii) the serum estradiol level on the trigger day divided by the number of mature oocytes, (iv) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day, (v) the serum estradiol level on the trigger day divided by the number of mature oocytes and then by the number of grade 1 or 2 embryos obtained, and (vi) the serum estradiol level on the trigger day divided by the endometrial thickness on the trigger day and then by the number of grade 1 or 2 embryos obtained. The analysis covered 2421 IVF/ICSI cycles with an embryo transfer, leading to 753 clinical pregnancies (31.1% per transfer). Four ratios were significantly predictive in both centers; their discriminant power remained moderate (area under the receiver operating characteristic curve between 0.574 and 0.610). In contrast, the models’ calibration was excellent (coefficients: 0.943–0.978; p < 0.001). Our ratios were no better than existing models in IVF/ICSI programs. In fact, a strongly discriminant predictive model will be probably never be obtained, given the many factors that influence the occurrence of a pregnancy. Keywords IVF/ICSI . pregnancy . predictive factor . predictive model . validation
Introduction Infertility (defined as the inability to conceive after 1 year of regular unprotected sexual intercourse) affects about one couple in six [1]. In some cases, the absence of pregnancy is often
* Philippe Merviel [email protected] 1
ART Center, Brest University Hospital, 2 avenue Foch, 29200 Brest, France
2
Department of Gynecology, Obstetrics and Reproductive Medicine, Brest University Hospital, 2 avenue Foch, F-29200 Brest, France
3
ART Center, Amiens University Hospital, 1 rond-point du professeur Christian Cabrol, 80054 Amiens, France
found to be caused by several factors; conversely, the infertility may be completely un
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