基于贝叶斯网络模型的冻融胚胎移植活产结局路径分析

Path analysis of live birth outcomes following frozen-thawed embryo transfer based on Bayesian Network Model

摘要

目的 探索冻融胚胎移植活产结局的关键影响因素,并构建贝叶斯网络解析动态路径。方法 本研究基于2021年1月至2023年12月西京医院妇产科生殖中心冻融胚胎移植队列,采用LASSO回归筛选影响活产结局的关键因素,基于筛选出的变量构建贝叶斯网络模型并进行路径分析。结果 研究期间共收集1 152例冻融胚胎移植个案及相关临床资料,移植活产率为35.3%(n=407)。基于LASSO回归筛选出年龄、不孕年限、体质指数(BMI)、治疗方案、内膜形态、外管血染、胚胎发育天数、移植胚胎数、移植胚胎评价9个关键影响因素,构建贝叶斯网络分析揭示了40条活产结局路径。基于冻融胚胎移植评价指标发现单冻融优质胚胎移植策略(活产率41.4%)优于任意双冻融胚胎移植;胚胎移植外管血染的发生降低了活产率(39.8% vs. 35.3%),并通过“内膜形态”中介路径进一步降低活产率;具有优质内膜形态的冻融胚胎移植后活产率最高(51.2%),但是孕妇肥胖可间接降低活产概率。结论 本研究基于贝叶斯网络模型明确了冻融胚胎移植活产结局的关键因素及其影响路径,为制定临床治疗方案、规避风险并提高冻融胚胎移植活产率提供了科学依据。

Abstract

Objective To explore key factors influencing live birth outcomes following frozen-thawed embryo transfer (FET),and build a Bayesian network for dynamic path inference. Methods A cohort of FET cycles conducted in Reproductive Center,Department of Gynecology and Obstetrics,The First Affiliated Hospital of Air Force Military Medical University from January 2021 to December 2023 was selected in this study.Least Absolute Shrinkage and Selection Operator (LASSO) regression was used to identify key factors affecting live birth outcomes.The optimal parameter λ was selected through 10-fold cross-validation to prevent overfitting.Based on the selected variables,a Bayesian network model was constructed for path analysis. Results A total of 1 152 cases of FET and related clinical data of the infertile women were collected,and the live birth rate following FET was 35.3% (n=407).By LASSO regression analysis,nine key influencing factors were identified as follows:age,duration (year) of infertility,maternal body mass index (BMI),treatment regimen,endometrial morphology,catheter blood staining,embryo development days,number of embryos transferred,and transferred embryo quality evaluation.The constructed Bayesian network model revealed 40 paths to live birth outcomes,of which,the path of transferred embryos quality evaluation indicators showed that the strategy of transferring a single high-quality frozen-thawed embryo (the live birth rate was 41.4%) was superior to those strategies of transferring any two frozen-thawed embryos;occurrence of catheter blood staining during embryo transfer reduced the live birth rate and this live birth rate was further decreased via the mediating path of “endometrial morphology” (35.3%) (via the direct path,the live birth rate in absence of catheter blood staining during embryo transfer was 39.8%);FET with optimal endometrial morphology achieved the highest live birth rate (51.2%);however,maternal overweight or obesity could indirectly reduce probability of live birth. Conclusion The current live birth rate following FET remains nonideal and still needs improvement.Such favorable factors as appropriate maternal age,absence of catheter blood staining during embryo transfer,and absence of maternal overweight or obesity can significantly improve the live birth rate.The Bayesian network model constructed in this study identifies key factors and their related influencing paths for live birth outcomes following FET,which provides scientific basis for formulating clinical treatment strategies,avoiding risks and improving live birth rate following FET.

关键词

辅助生殖技术 / 冻融胚胎移植 / 活产 / 贝叶斯网络 / 路径分析

Key words

assisted reproductive technology / frozen-thawed embryo transfer / live birth / Bayesian network / path analysis

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基金资助

陕西省创新能力支撑计划(2024CX-GXPT-32)

西安市科技计划(22YXYJ0152)