Table 2.
Controlled ovarian stimulation cycle related characteristics of the training and validation cohorts.
| Training cohort | Validation cohort | Training vs. validation | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Controln = 11,918 | Moderate/severe OHSS n = 293 | Totaln = 12211 | P value | Controln = 5102 | Moderate/severe OHSS n = 132 | Totaln = 5234 | P value | P value | |
| COS cycle number | 1 (1–1) | 1 (1–1) | 0.003 | 1 (1–1) | 1 (1–1) | 1 (1–1) | 0.027 | 0.339 | |
| First cycle | 9,621 (80.73%) | 260 (88.74%) | 9,881 (80.92%) | 4,085 (80.07%) | 117 (88.64%) | 4,202 (80.28%) | |||
| Second cycle | 2,052 (17.22%) | 32 (10.92%) | 2,084 (17.07%) | 910 (17.84%) | 14 (10.61%) | 924 (17.65%) | |||
| COS protocol | 0.605 | ||||||||
| GnRH agonist protocol | 7,399 (62.1%) | 185 (63.1%) | 7,584 (62.1%) | 0.712 | 3,148 (61.7%) | 81 (61.4%) | 3,229 (61.7%) | 0.937 | 0.605 |
| GnRH antagonist protocol | 4,519 (37.9%) | 108 (36.9%) | 4,627 (37.9%) | 1,954 (38.3%) | 51 (38.6%) | 2,005 (38.3%) | |||
| Gn duration | 11.15 ± 2.22 | 10.79 ± 1.94 | 11.14 ± 2.22 | 0.012 | 11.11 ± 2.23 | 11.09 ± 2.27 | 11.11 ± 2.24 | 0.952 | 0.145 |
| Total dose of Gn (IU) | 2,025 (1,500–2,775) | 1650 (1,231.25–2,175) | 2025 (1,500–2,737.5) | <.001 | 2,025 (1,500–2,812.5) | 1637 (1,200–2,090.63) | 2,025 (1,500–2,775) | <.001 | 0.466 |
| Mean dose of Gn (IU) | 187.5 (150–225) | 150 (125–187.5) | 187.5 (150–225) | <.001 | 187.5 (150–230) | 150 (125–187.5) | 187.5 (150–230) | <.001 | 0.062 |
| Initial dose of Gn (IU) | 150 (150–225) | 150 (112.5–150) | 150 (150–225) | <.001 | 150 (150–225) | 150 (112.5–150) | 150 (150–225) | <.001 | 0.025 |
| Number of follicles on trigger day | |||||||||
| Follicles ≥ 10 mm | 17 (11–24) | 19 (14–26) | 17 (11–24) | <.001 | 17 (11–24) | 20 (15–32) | 17 (11–24) | <.001 | 0.543 |
| Follicles ≥ 14 mm | 10 (7–13) | 11 (9–14) | 10 (7–13) | <.001 | 10 (7–13) | 12 (9–16.5) | 10 (7–13) | <.001 | 0.828 |
| Follicles ≥ 16 mm | 7 (5–9) | 8 (6–10) | 7 (5–9) | <.001 | 7 (5–9) | 7.5 (6–10) | 7 (5–9) | 0.002 | 0.669 |
| Follicles ≥ 18 mm | 4 (2–5) | 4 (3–6) | 4 (2–5) | 0.002 | 4 (2–5) | 4 (2–5) | 4 (2–5) | 0.299 | 0.644 |
| Hormonal levels on trigger day | |||||||||
| LH (IU/L) | 1.33 ± 1.45 | 1.45 ± 1.42 | 1.33 ± 1.45 | 0.037 | 1.31 ± 1.15 | 1.25 ± 1.05 | 1.31 ± 1.15 | 0.29 | 0.445 |
| P (nmol/L) | 2.77 ± 1.98 | 2.43 ± 1.42 | 2.76 ± 1.97 | <.001 | 2.79 ± 1.77 | 2.80 ± 2.07 | 2.79 ± 1.77 | 0.319 | 0.271 |
| E2 (pmol/L) | 0.038 | 0.006 | 0.796 | ||||||
| E2 ≤ 1,835 | 69 (0.6%) | 0 (0.0%) | 69 (0.6%) | 25 (0.5%) | 0 (0.0%) | 25 (0.5%) | |||
| 1,835 < E2 ≤ 3,670 | 408 (3.4%) | 2 (0.7%) | 410 (3.4%) | 165 (3.2%) | 0 (0.0%) | 165 (3.2%) | |||
| 3,670 < E2 ≤ 18,350 | 8,895 (74.6%) | 225 (76.8%) | 9,120 (74.7%) | 3,833 (75.1%) | 90 (68.2%) | 3,923 (75.0%) | |||
| E2 > 18,350 | 2,546 (21.4%) | 66 (22.5%) | 2,612 (21.4%) | 1,079 (21.1%) | 42 (31.8%) | 1,121 (21.4%) | |||
| Type of trigger | |||||||||
| HCG alone | 10,135 (85.0%) | 284 (96.9%) | 10,419 (85.3%) | <.001 | 4,313 (84.5%) | 123 (93.2%) | 4,436 (84.8%) | 0.013 | 0.556 |
| GnRHa alone | 644 (5.4%) | 1 (0.3%) | 645 (5.3%) | 294 (5.8%) | 1 (0.8%) | 295 (5.6%) | |||
| Dual trigger | 1,139 (9.6%) | 8 (2.7%) | 1,147 (9.4%) | 495 (9.7%) | 8 (6.1%) | 503 (9.6%) | |||
| Number of oocytes retrieved | 13 (9–18) | 15.5 (11–22) | 13 (9–18) | <.001 | 13 (9–18) | 15.5 (11–22) | 13 (9–18) | <.001 | 0.779 |
| ≤10 | 4,218 (35.4%) | 73 (24.9%) | 4,291 (35.1%) | <.001 | 1,844 (36.1%) | 30 (22.7%) | 1,874 (35.8%) | <.001 | 0.594 |
| 11–20 | 5,637 (47.3%) | 175 (59.7%) | 5,812 (47.6%) | 2,378 (46.6%) | 61 (46.2%) | 2,439 (46.6%) | |||
| 21–30 | 1,719 (14.4%) | 32 (10.9%) | 1,751 (14.3%) | 727 (14.2%) | 29 (22.0%) | 756 (14.4%) | |||
| > 30 | 344 (2.9%) | 13 (4.4%) | 357 (2.9%) | 153 (3.0%) | 12 (9.1%) | 165 (3.2%) | |||
| Freeze all | |||||||||
| No | 7,469 (62.7%) | 232 (79.2%) | 7,701 (63.1%) | <.001 | 3,172 (62.2%) | 89 (67.4%) | 3,261 (62.3%) | 0.219 | 0.340 |
| Yes | 4,449 (37.3%) | 61 (20.8%) | 4,510 (36.9%) | 1,930 (37.8%) | 43 (32.6%) | 1,973 (37.7%) | |||
| Fertilization type | |||||||||
| 1 = IVF | 9,786 (82.1%) | 246 (84.0%) | 10,032 (82.2%) | 0.623 | 4,145 (81.2%) | 108 (81.8%) | 4,253 (81.3%) | 0.951 | 0.178 |
| 2 = ICSI | 2,118 (17.8%) | 47 (16.0%) | 2,165 (17.7%) | 954 (18.7%) | 24 (18.2%) | 978 (18.7%) | |||
| 3 = IVF/ICSI | 14 (0.1%) | 0 (0.0%) | 14 (0.1%) | 3 (0.1%) | 0 (0.0%) | 3 (0.1%) | |||
| Origin of sperm | |||||||||
| 1 = husband | 11,852 (99.4%) | 290 (99.0%) | 12,142 (99.4%) | 0.289 | 5,071 (99.4%) | 131 (99.2%) | 5,202 (99.4%) | 0.827 | 0.712 |
| 2 = sperm bank | 66 (0.6%) | 3 (1.0%) | 69 (0.6%) | 31 (0.6%) | 1 (0.8%) | 32 (0.6%) | |||
| Type of sperm | |||||||||
| 1 = fresh | 11,799 (99.0%) | 289 (98.6%) | 12,088 (99.0%) | 0.535 | 5,050 (99.0%) | 131 (99.2%) | 5,181 (99.0%) | 0.767 | 0.974 |
| 2 = frozen | 119 (1.0%) | 4 (1.4%) | 123 (1.0%) | 52 (1.0%) | 1 (0.8%) | 53 (1.0%) | 0.349 | ||
| Number of cycles with ET | 6,078 (51.0%) | 216 (73.7%) | 6,294 (51.5%) | <.001 | 2,574 (50.5%) | 82 (62.1%) | 2,656 (50.7%) | 0.008 | 0.334 |
| Number of cycles with canceled ET | 5,840 (49.0%) | 77 (26.3%) | 5,917 (48.5%) | 2,528 (49.5%) | 50 (37.9%) | 2,578 (49.3%) | |||
| Number of embryos for ET | 2 (1,2) | 2 (2,2) | 2 (1,2) | 0.026 | 2 (1,2) | 2 (2,2) | 2 (1,2) | 0.122 | 0.233 |
| n = 1 | 1,902 (31.3%) | 50 (23.1%) | 1,952 (31.0%) | 0.025 | 842 (32.7%) | 19 (22.6%) | 861 (32.4%) | 0.059 | 0.399 |
| n = 2 | 4,082 (67.2%) | 164 (75.9%) | 4,246 (67.5%) | 1,689 (65.6%) | 65 (77.4%) | 1,754 (66.0%) | |||
| n = 3 | 94 (1.5%) | 2 (0.9%) | 96 (1.5%) | 43 (1.7%) | 0 (0.0%) | 43 (1.6%) | |||
| Number of top-quality embryos for ET | 1 (0,2) | 1 (1,2) | 1 (0,2) | <.001 | 1 (0,2) | 2 (1,2) | 1 (0,2) | 0.001 | 0.506 |
| n = 0 | 1,885 (31.0%) | 45 (20.8%) | 1,930 (30.7%) | <.001 | 747 (29.0%) | 15 (18.3%) | 762 (28.7%) | 0.004 | 0.089 |
| n = 1 | 2,161 (35.6%) | 72 (33.0%) | 2,233 (35.5%) | 987 (38.3%) | 25 (30.5%) | 1,012 (38.1%) | |||
| n = 2 | 2,006 (33.0%) | 98 (45.4%) | 2,104 (33.4%) | 831 (32.3%) | 42 (51.2%) | 873 (32.9%) | |||
| Number of blastocysts for ET | 0 (0,0) | 0 (0,0) | 0 (0,0) | 0.566 | 0 (0,0) | 0 (0,0) | 0 (0,0) | 0.753 | 0.662 |
| n = 0 | 5,265 (86.6%) | 184 (85.2%) | 5,449 (86.6%) | 0.076 | 2,237 (86.9%) | 72 (87.8%) | 2,309 (86.9%) | 0.341 | 0.778 |
| n = 1 | 674 (11.1%) | 31 (14.4%) | 705 (11.2%) | 275 (10.7%) | 10 (12.2%) | 285 (10.7%) | |||
| n = 2 | 139 (2.3%) | 1 (0.5%) | 140 (2.2%) | 62 (2.4%) | 0 (0.0%) | 62 (2.3%) | |||
OHSS, ovarian hyper-stimulation syndrome; COS, controlled ovarian stimulation; GnRH, gonadotropin-releasing hormone; Gn, gonadotropin; LH, luteinizing hormone; P, progesterone; E2, estradiol; HCG, human chorionic gonadotropin; GnRHa, gonadotropin-releasing hormone agonist; IVF, in vitro fertilization; ICSI, intra-cytoplasmic sperm injection; ET, embryo transfer.