The threshold effect of factors associated with spontaneous abortion in human-assisted reproductive technology

Abstract

We explored the independent risk factors associated with cases of spontaneous abortion in infertile patients treated with human-assisted reproductive technology (ART) and established a smooth curve fit and perform a threshold effect analysis can provide guidance and a valuable reference for predicting the probability of spontaneous abortion. This was a retrospective cohort study of 16,097 patients successfully conceived with ART in Shangqiu First People's Hospital from June 2013 to December 2018. Overall, 2,378 (14.77%) had an abortion and 13,719 (85.23%) did not have an abortion. Multivariate logistic regression analysis showed that female age (OR 1.050; 95% CI 1.032–1.069; P < 0.001), male age (OR 1.100; 95% CI 1.086–1.115; P < 0.001), follicular-stimulating hormone (OR 1.049; 95% CI 1.022–1.076; P < 0.001), anti-Mullerian hormone (OR 0.893; 95% CI 0.862–0.925; P < 0.001) and the number of fetuses at pregnancy diagnosis were independent factors associated with spontaneous abortion. The threshold effect analysis found that when female age > 32 years (cut-off point) old, age and the risk of spontaneous abortion were positively correlated. When follicular-stimulating hormone > 6.1 IU/L (cut-off point), follicular-stimulating hormone was positively correlated with the occurrence of spontaneous abortion, When anti-Mullerian hormone ≤ 3.1 ng/mL (cut-off point), anti-Mullerian hormone was negatively correlated with the occurrence of spontaneous abortion and there was a linear positive correlation between antral Follicle Counting and live birth. In addition, the older the male age, the higher the incidence of abortion. The smooth curve fit and threshold effect analyses can provide a more detailed estimate of the probability of spontaneous abortion for pregnant couples.

Non-linear Relationship of Maternal Age With Risk of Spontaneous Abortion: A Case-Control Study in the China Birth Cohort

“…Feodor et al ( 18 ) found that the risk of spontaneous abortion in pregnant women was significantly higher when maternal age was over 40 years old. Two small-sample studies in China found that pregnant women who were 32 years old or older showed a stronger risk association with spontaneous abortion ( 20 , 21 ).…”

“…However, the majority of studies categorized participants as either above or below 30 or 35 years old, which limited the comparability between scientific and clinical guidance given by different studies. Most domestic studies concentrated on establishing a linear relationship between maternal age and risk of spontaneous abortion or recurrent miscarriage, and only two small-sample studies discussed a non-linear relationship between maternal age and risk of spontaneous abortion, finding that the risk is slightly elevated in the youngest mothers and then rose sharply in mothers 32 years and older ( 20 , 21 ). The precise form of the non-linear relationship between maternal age and spontaneous abortion risk is unclear, nor is there any discussion of a threshold effect of that.…”

Adverse maternal and neonatal outcomes of preimplantation genetic testing with trophectoderm biopsy: A retrospective cohort study of 3373 intracytoplasmic sperm injection single frozen-thawed blastocyst transfer cycles

“…In addition, the spontaneous abortion rate increases 35 . Chen, L., et al have proven that the development days and quality of biopsied blastocysts affect the abortion rate 37 . High-quality blastocysts are associated with a higher implantation rate and live rate.…”

Nursing Care for Mothers With Incomplete Abortions: Case Study

“…With age, the number and quality of oocytes significantly decreases, the number of mitochondria decreases, there is a significant decrease in the content of ATP in the cytoplasm, and the proportion of abnormal embryonic chromosomal structures increases. Spontaneous abortion is closely related to chromosomal abnormalities of the embryo18,19, several studies have shown that chromosomal abnormalities are the most common cause of spontaneous abortion so it can be concluded that the older a woman is, the higher the chances of having a spontaneous abortion (Li, Niu, Feng, Yan, & Chen, 2021). At the beginning of the abortion, bleeding occurs in the decidua basalis followed by necrosis of the surrounding tissue, this causes the products of conception to be partially detached, so that the uterus considers the products of conception to be foreign bodies that must be removed so that the uterus contracts.…”