Abstract
Research question
What are the factors influencing the fertility of patients with intrauterine adhesions
(IUA) after hysteroscopic adhesiolysis and which assessment system is more efficient
in predicting post-operative ongoing pregnancy?
Design
The clinical information of 369 individuals diagnosed with and treated for IUA were
obtained from the Multicentre Prospective Clinical Database for the Construction of
Predictive Models on Risk of Intrauterine Adhesion (NCT05381376) and randomly divided
into the training and validation cohorts. A univariate analysis was performed to identify
relevant clinical indicators, followed by a least absolute shrinkage and selection
operator (LASSO) regression for regularization and SHapley Additive exPlanation (SHAP)
for extreme gradient boosting (XGBoost) predictive model visualization. Finally, receiver
operating characteristic (ROC) curves were constructed to assess the model's efficiency.
Results
Univariate analysis and LASSO regression demonstrated that 12 clinical indicators
were significantly associated with post-operative ongoing pregnancy in IUA patients.
SHAP visualization indicated that post-operative Fallopian tube ostia, blood supply,
uterine cavity shape and age had the highest significance. The area under the ROC
curve (AUC) of the XGBoost model in the training and validation cohorts was 0.987
(95% CI 0.979–0.996) and 0.985 (95% CI 0.967–1), respectively. These values were significantly
higher than those of the American Fertility Society (AFS) classification, the Chinese
Society for Gynecological Endoscopy (CSGE) classification and endometrial thickness
(all P < 0.001).
Conclusions
The XGBoost model had higher accuracy in predicting post-operative reproductive outcomes
in IUA patients. Clinically, the model may be useful for managing and categorizing
IUA and determining optimal action to aid in pregnancy.
Keywords
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Biography
Hua Duan is the Director of the Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, China. She is also President of the Gynecologic Endoscopy Training Institute of the Chinese Medical Doctor Association, and Vice-President of the Chinese Society of Gynecology Endoscopy (CSGE).
Key message
This study found 12 clinical indicators that significantly influence the fertility of patients with intrauterine adhesions following hysteroscopic adhesiolysis. An XGBoost model was constructed; these have excellent clinical value in predicting post-operative ongoing pregnancy compared to AFS and CSGE classifications and endometrial thickness.
Article info
Publication history
Published online: January 30, 2023
Accepted:
January 23,
2023
Received:
November 24,
2022
Declaration: The authors report no financial or commercial conflicts of interest.Identification
Copyright
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
