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?
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.
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).
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.
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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).
Accepted: January 23, 2023
Received: November 24, 2022
Publication stageIn Press Journal Pre-Proof
© 2023 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.