Abstract
Research Question
What are the factors influencing the fertility of patients with intrauterine adhesions
(IUAs) after hysteroscopic adhesiolysis and which assessment system is more efficient
in predicting postoperative reproductive outcomes?
Design
The clinical informations of 369 individuals diagnosed with and treated for IUAs were
obtained from the Intrauterine Adhesion Multicenter Prospective Clinical Database
(IUADB, 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 postoperative reproductive outcomes in IUAs patients.
SHAP visualization indicated that postoperative 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 0.9787-0.996) and 0.9851 (95% CI 0.9668-1), respectively. These values were
significantly higher than those of the American Fertility Society (AFS) classification,
the Chinese Society for Gynaecological Endoscopy (CSGE) classification and endometrial
thickness (all P < 0.01).
Conclusions
The XGBoost model had higher accuracy in predicting postoperative reproductive outcomes
in IUAs patients. Clinically, our model may be useful for managing and categorizing
IUAs 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).
Article info
Publication history
Accepted:
January 23,
2023
Received:
November 24,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
