The Factors Affecting Reproductive Outcomes Of Unexplained Infertile Couples Following Intrauterine Insemination And Construction Of Prediction Models

Objective To investigate the influencing factors affecting the reproductive outcomes of unexplained infertile couples following intrauterine insemination,and construct prediction models of their reproductive outcomes.Methods The clinical data of the unexplained infertile couples(female,less than40 years old)and the anti-Müllerian hormone level > 1.1 ng/m L)were retrospectively analysed.2601 cycles of 1097 couples treated in the Reproductive Center of the Third affiliated Hospital of Guangzhou Medical University from 1st April 2013 to 12 th November 2020 were retrospectively studied.The primary and secondary outcomes of this study were the live birth rate per cycle and the clinical pregnancy rate per cycle,respectively.Case control study was used.Prediction models for live birth rates and clinical pregnancy rates were developed using logistic regression,and their accuracies were determined by areas under the receiver operating characteristic curve(AUC).We set the nomogram by the language R,and the nomogram can predict the pregnancy outcome of patients individually.The prediction model was validated by the AUC in validation group.Results The study included 2601 cycles of IUI for unexplained infertile couples.multivariate logistic regression analyses of the clinical data from the live birth group vs.non live birth group,and from clinical pregnancy group vs.non clinical pregnancy group;we found that,AMH levels(live birth:OR = 1.07,95%CI:1.02-1.12,P= 0.006,and clinical pregnancy,OR = 1.06,95%CI:1.02-1.11,P= 0.008)and ovarian stimulation(live birth:OR = 4.74,95%CI:3.46-6.53,P< 0.001,and clinical pregnancy,OR =4.35,95%CI:3.28-5.75,P< 0.001)had significant impacts on the reproductive outcomes.Prediction models with AMH levels and ovarian stimulation could predict the live birth rate and clinical pregnancy rate per cycle with AUC at 0.70(95%CI:0.66-0.74)for the live birth and at 0.69(95%CI:0.65-0.72)for the clinical pregnancy.In validation group,prediction models could predict the live birth rate and clinical pregnancy rate per cycle with AUC at 0.65(95%CI:0.61-0.69)and 0.65(95%CI:0.61-0.68),respectively.The model had good calibration and sensitivityConclusion Prediction models with ovulation stimulation and AMH levels can predict live birth rate and clinical pregnancy rate of unexplained infertile couples following AIH.Those with high AMH levels and the help of ovarian stimulation could end up with better reproductive outcomes of UI following AIH.