The (decision) tree of fertility: an innovative decision-making algorithm in assisted reproduction technique

Abstract

Purpose Several mathematical models have been developed to estimate individualized chances of assisted reproduction techniques (ART) success, although with limited clinical application. Our study aimed to develop a decisional algorithm able to predict pregnancy and live birth rates after controlled ovarian stimulation (COS) phase, helping the physician to decide whether to perform oocytes pick-up continuing the ongoing ART path. Methods A single-center retrospective analysis of real-world data was carried out including all fresh ART cycles performed in 1998-2020. Baseline characteristics, ART parameters and biochemical/clinical pregnancies and live birth rates were collected. A seven-steps systematic approach for model development, combining linear regression analyses and decision trees (DT), was applied for biochemical, clinical pregnancy, and live birth rates. Results Of fresh ART cycles, 12,275 were included. Linear regression analyses highlighted a relationship between number of ovarian follicles > 17 mm detected at ultrasound before pick-up (OF17), embryos number and fertilization rate, and biochemical and clinical pregnancy rates (p < 0.001), but not live birth rate. DT were created for biochemical pregnancy (statistical power-SP:80.8%), clinical pregnancy (SP:85.4%), and live birth (SP:87.2%). Thresholds for OF17 entered in all DT, while sperm motility entered the biochemical pregnancy's model, and female age entered the clinical pregnancy and live birth DT. In case of OF17 < 3, the chance of conceiving was < 6% for all DT. Conclusion A systematic approach allows to identify OF17, female age, and sperm motility as pre-retrieval predictors of ART outcome, possibly reducing the socio-economic burden of ART failure, allowing the clinician to perform or not the oocytes pick-up.

Which sperm parameter limits could really guide the clinical decision in assisted reproduction?

“…Here, we confirm the difference between IVF and ICSI cycles previously reported 27,28 . In particular, couples treated with IVF showed lower female age, better semen parameters, and lower duration of stimulation, although higher FSH dosages were used (Table 1).…”

“…Considering strong ART outcomes, the overall biochemical pregnancy rate was 20.7% (3086 cycles), with Here, we confirm the difference between IVF and ICSI cycles previously reported. 27,28 In particular, couples treated with IVF showed lower female age, better semen parameters, and lower duration of stimulation, although higher FSH dosages were used (Table 1). On the contrary, oocytes injected/inseminated and embryos obtained were higher in ICSI rather than in IVF cycles (Table 1).…”

Awareness of infertility amongst women of reproductive age in southern Nigerian study

“…[4,5] However, the merit of using this information about reproductive health from websites or smart phone could be limited among women who use these , the use of daily selftiming therapy with these application services would be more convenient. [4,5,[7][8][9][10]…”

Influence of Adherence to the Mediterranean Diet on Assisted Reproductive Techniques Outcomes: A Systematic Review

“…Regarding factors that can influence the outcomes of ART, increasing attention is being paid to the impact of lifestyles and dietary habits in particular [10]. However, interest has shifted from studying isolated nutrients or food groups such as dairy or whole grains to investigating dietary patterns [10].…”

“…Regarding factors that can influence the outcomes of ART, increasing attention is being paid to the impact of lifestyles and dietary habits in particular [10]. However, interest has shifted from studying isolated nutrients or food groups such as dairy or whole grains to investigating dietary patterns [10]. This is due to the synergistic and/or antagonistic effects that nutrients present with each other and, more importantly, because focusing on dietary patterns better reflects long-term dietary habits [10].…”