Prediction of spontaneous pregnancy in patients with chronic endometritis and reproductive dysfunction using neural network technology (secondary analysis of the results of the "TULIP" randomized controlled trial)

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Relevance: The patients with chronic endometritis (CE) in comparison with patients without it have significantly lower rates of pregnancy (30.8% vs. 63.0%) and live births (7.7% vs. 51.9%, respectively). The prediction of pregnancy in patients with CE after treatment is of scientific and practical interest.

Objective: To develop a prognostic model of the probability of spontaneous pregnancy in patients with CE and reproductive dysfunction using neural network technology and evaluate its effectiveness.

Materials and methods: The secondary analysis of the results of the "TULIP" randomized controlled trial was carried out. A total of 875 patients with the results of a comprehensive examination were selected from the electronic database. The patients were divided into two comparison groups: group I (n=461, 52.7%) included patients who did not become pregnant, group II (n=414, 47.3%) included those who became pregnant.

Results: A prognostic model was created on the basis of neural network technology; 12 of the most significant parameters were used for this model. The prognosis was positive in 94.2% of patients in group II, and it was negative in 5.8% of women. The accuracy of the prediction was 88.0% (sensitivity is 94.2%, specificity is 82.4%). The information value of the model was confirmed by ROC analysis, the area under the curve (ROC-AUC) was 0.88, p<0.001. The use of the Superlymph medication was shown to have a significant effect on the rate of spontaneous pregnancy and it was an important parameter in the prognostic model. The oxygenation index obtained using the Photon-Bio spectrometer plays a significant role since the accuracy of the prediction decreases to 83.2% when the index is absent in the model. An online calculator was developed for the practical use of the model.

Conclusion: The model for predicting spontaneous pregnancy in patients with CE using neural network technology has an accuracy of 88% and it allows the clinicians to determine the need for either repeated courses of treatment for CE (if the prognosis is negative), or to make a decision on pregnancy planning (if the prognosis is positive).

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作者简介

Anton Sukhanov

Perinatal Medical Center; Tyumen State Medical University, Ministry of Health of Russia

编辑信件的主要联系方式.
Email: saa2505anton@yandex.ru
ORCID iD: 0000-0001-9092-9136

PhD, Head of the Department of Family Planning and Reproduction, Tyumen Regional Perinatal Center, Associate Professor, Department of Obstetrics and Gynecology

俄罗斯联邦, 1 Daudelnaya str., Tyumen, 625002; 10 Permyakov str., Tyumen, 625013

Galina Dikke

F.I. Inozemtsev Academy of Medical Education

Email: galadikke@yandex.ru
ORCID iD: 0000-0001-9524-8962

Dr.Med. Sci., Professor, Department of Obstetrics and Gynecology with a Course of Reproductive Medicine

俄罗斯联邦, 22 Liter M, Moskovskiy Ave., Saint Petersburg, 190013

Viktor Mudrov

Chita State Medical University, Ministry of Health of Russia

Email: mudrov_viktor@mail.ru
ORCID iD: 0000-0002-5961-5400

Dr.Med. Sci., Associate Professor, Associate Professor of the Department of Obstetrics and Gynecology, Faculty of Pediatrics and Faculty of Additional Professional Education

俄罗斯联邦, 39a, Gorkogo str., Chita, 672000

Irina Kukarskaya

Perinatal Medical Center; Tyumen State Medical University, Ministry of Health of Russia

Email: such-anton@yandex.ru
ORCID iD: 0000-0002-8275-3553

Dr.Med. Sci., Professor of the Department of Obstetrics, Gynecology and Reanimatology with a Course of Clinical Laboratory Diagnostics

俄罗斯联邦, 1 Daudelnaya str., Tyumen, 625002; 10 Permyakov str., Tyumen, 625013

参考

  1. Kimura F., Takebayashi A., Ishida M., Nakamura A., Kitazawa J., Morimune A. et al. Review: Chronic endometritis and its effect on reproduction. J. Obstet. Gynaecol. Res. 2019; 45(5): 951-60. https://dx.doi.org/10.1111/jog.13937.
  2. Hirata K., Kimura F., Nakamura A., Kitazawa J., Morimune A., Hanada T. et аl. Histological diagnostic criterion for chronic endometritis based on the clinical outcome. BMC Women's Health. 2021; 21: 94. https://dx.doi.org/10.1186/s12905-021-01239-y.
  3. Vitagliano A., Laganà A.S., De Ziegler D., Cicinelli R., Santarsiero C.M., Buzzaccarini G. et al. Chronic endometritis in infertile women: impact of untreated disease, plasma cell count and antibiotic therapy on IVF outcome – a systematic review and meta-analysis. Diagnostics (Basel). 2022; 12(9): 2250. https://dx.doi.org/10.3390/diagnostics12092250.
  4. Liu J., Liu Z.A., Liu Y., Cheng L., Yan L. Impact of antibiotic treatment for chronic endometritis on pregnancy outcomes in women with reproductive failures (RIF and RPL): A systematic review and meta-analysis. Front. Med. (Lausanne). 2022; 9: 980511. https://dx.doi.org/10.3389/fmed.2022.980511.
  5. Краснопольская К.В., Назаренко Т.А., Ершова И.Ю. Современные подходы к оценке рецептивности эндометрия (обзор литературы). Проблемы репродукции. 2016; 22(5): 61 9. [Krasnopol'skaia K.V., Nazarenko T.A., Ershova I.Yu. Modern approaches to endometrial receptivity assessment (a review). Russian Journal of Human Reproduction. 2016; 22(5): 61-9 (in Russian)]. https://dx.doi.org/10.17116/repro201622561-69.
  6. Craciunas L., Gallos I., Chu J., Bourne T., Quenby S., Brosens J.J., Coomarasamy A. Conventional and modern markers of endometrial receptivity: a systematic review and meta-analysis. Hum. Reprod. Update. 2019; 25(2): 202-23. https://dx.doi.org/10.1093/humupd/dmy044.
  7. McLernon D.J., Steyerberg E.W., Te Velde E.R., Lee A.J., Bhattacharya S. Predicting the chances of a live birth after one or more complete cycles of in vitro fertilisation: population based study of linked cycle data from 113 873 women. BMJ. 2016; 355: i5735. https://dx.doi.org/10.1136/bmj.i5735.
  8. Vaegter K.K., Lakic T.G., Olovsson M., Berglund L., Brodin T., Holte J. Which factors are most predictive for live birth after in vitro fertilization and intracytoplasmic sperm injection (IVF/ICSI) treatments? Analysis of 100 prospectively recorded variables in 8,400 IVF/ICSI single-embryo transfers. Fertil. Steril. 2017; 107(3): 641-8.e2. https://dx.doi.org/10.1016/ j.fertnstert.2016.12.005.
  9. Xu T., de Figueiredo Veiga A., Hammer K.C., Paschalidis I.C., Mahalingaiah S. Informative predictors of pregnancy after first IVF cycle using eIVF practice highway electronic health records. Sci. Rep. 2022; 12(1): 839. https://dx.doi.org/10.1038/s41598-022-04814-x.
  10. Ratna M.B., Bhattacharya S., Abdulrahim B., McLernon D.J. A systematic review of the quality of clinical prediction models in in vitro fertilisation. Hum. Reprod. 2020; 35(1): 100-16. https://dx.doi.org/10.1093/humrep/ dez258.
  11. Дикке Г.Б., Суханов А.А., Остроменский В.В., Кукарская И.И. Течение и исходы беременности у пациенток с хроническим эндометритом и нарушением репродуктивной функции, получавших комплексное лечение с использованием препарата «Суперлимф» (рандомизированное контролируемое испытание в параллельных группах «ТЮЛЬПАН»). Акушерство и гинекология. 2023; 4: 132-44. [Dikke G.B., Sukhanov A.A., Ostromensky V.V., Kukarskaya I.I. Course and outcomes of pregnancy in patients with chronic endometritis and impaired reproductive function after receiving complex treatment with drug Superlymph: randomized control trial in parallel groups “TULIP”. Obstetrics and Gynecology. 2023; (4): 132-44. (in Russian)]. https://dx.doi.org/10.18565/aig.2023.74.
  12. Broer S.L., van Disseldorp J., Broeze K.A., Dolleman M., Opmeer B.C., Bossuyt P. et al. Added value of ovarian reserve testing on patient characteristics in the prediction of ovarian response and ongoing pregnancy: an individual patient data approach. Hum. Reprod. Update. 2013; 19(1): 26-36. https://dx.doi.org/10.1093/humupd/dms041.
  13. Lukaszuk K., Kunicki M., Liss J., Lukaszuk M., Jakiel G. Use of ovarian reserve parameters for predicting live births in women undergoing in vitro fertilization. Eur. J. Obstet. Gynecol. Reprod. Biol. 2013; 168(2): 173-7. https://dx.doi.org/10.1016/j.ejogrb.2013.01.013.
  14. Zhang Q., Wang X., Zhang Y., Lu H., Yu Y. Nomogram prediction for the prediction of clinical pregnancy in Freeze-thawed Embryo Transfer. BMC Pregnancy Childbirth. 2022; 22(1): 629. https://dx.doi.org/10.1186/ s12884-022-04958-8.
  15. Hansen K.R., He A.L., Styer A.K., Wild R.A., Butts S., Engmann L. et al.; Eunice Kennedy Shriver National Institute of Child Health and Human Development Reproductive Medicine Network. Predictors of pregnancy and live-birth in couples with unexplained infertility after ovarian stimulation-intrauterine insemination. Fertil. Steril. 2016; 105(6): 1575-83.e2. https://dx.doi.org/10.1016/j.fertnstert.2016.02.020.
  16. Kuru Pekcan M., Tokmak A., Ulubasoglu H., Kement M., Özakşit G. The importance of infertility duration and follicle size according to pregnancy success in women undergoing ovulation induction with gonadotropins and intrauterine insemination. J. Obstet. Gynaecol. 2023; 43(1): 2173058. https://dx.doi.org/ 10.1080/01443615.2023.2173058.
  17. Zhang L., Cai H., Li W., Tian L., Shi J. Duration of infertility and assisted reproductive outcomes in non-male factor infertility: can use of ICSI turn the tide? BMC Womens Health. 2022; 22(1): 480. https://dx.doi.org/10.1186/s12905-022-02062-9.
  18. Abdelazim I., Purohit P., Farag R., Zhurabekova G. Unexplained infertility: prevalence, possible causes and treatment options. A review of the literature. J. Obstet. Gynecol. Investig. 2018; 1(1): 17-22. https://dx.doi.org/10.5114/jogi.2018.74250.
  19. Buzzaccarini G., Vitagliano A., Andrisani A., Santarsiero C.M., Cicinelli R., Nardelli C. et al. Chronic endometritis and altered embryo implantation: a unified pathophysiological theory from a literature systematic review. J. Assist. Reprod. Genet. 2020; 37(12): 2897-911. https://dx.doi.org/10.1007/ s10815-020-01955-8.
  20. Тапильская Н.И., Толибова Г.Х., Савичева А.М., Копылова А.А., Глушаков Р.И., Будиловская О.В., Крысанова А.А., Горский А.Г., Гзгзян А.М., Коган И.Ю. Эффективность локальной цитокинотерапии хронического эндометрита пациенток с бесплодием. Акушерство и гинекология. 2022; 2: 91-100. [Tapilskaya N.I., Tolibova G.Kh., Savicheva A.M., Kopylova A.A., Glushakov R.I., Budilovskaya O.V., Krysanova A.A., Gorskii A.G., Gzgzyan A.M., Kogan I.Yu. The effectiveness of local cytokine therapy for chronic endometritis in patients with infertility. Obstetrics and Gynecology. 2022; (2): 91-100. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.2.91-100.
  21. Доброхотова Ю.Э., Ганковская Л.В, Боровкова Е.И., Зайдиева З.С., Скальная В.С. Модулирование локальной экспрессии факторов врожденного иммунитета у пациенток с хроническим эндометритом и бесплодием. Акушерство и гинекология. 2019; 5: 125-32. [Dobrokhotova Yu.E., Gankovskaya L.V., Borovkova E.I., Zaidieva Z.S., Skalnaya V.S. Modulation of the local expression of innate immune factors in patients with chronic endometritis and infertility. Obstetrics and Gynecology. 2019; (5): 125-32. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.5.125-132.
  22. Дикке Г.Б., Суханов А.А., Кукарская И.И., Остроменский В.В. Цитокиновый профиль пациенток с хроническим эндометритом и нарушением репродуктивной функции. Вопросы гинекологии, акушерства и перинатологии. 2021; 20(6): 82-91. [Dikke G.B., Sukhanov A.A., Kukarskaya I.I., Ostromensky V.V. Cytokine profile in patients with chronic endometritis and reproductive dysorders. Gynaecology, Obstetrics and Perinatology. 2021; 20(6): 82-91. (in Russian)]. https://dx.doi.org/10.20953/1726-1678-2021-6-82-91.
  23. Liu M., Yuan Y., Qiao Y., Tang Y., Sui X., Yin P., Yang D. The effectiveness of immunomodulatory therapies for patients with repeated implantation failure: a systematic review and network meta-analysis. Sci. Rep. 2022; 12(1): 18434. https://dx.doi.org/10.1038/s41598-022-21014-9.
  24. Зуев В.М., Александров М.Т., Хомерики Т.А., Чернышов Г., Метревели Б.Г., Попов С.Н., Ибоян И.И., Калинина Е.А. Клиническое значение лазерного конверсионного тестирования в диагностике и лечении хронического эндометрита. Вестник РУДН. Серия: Медицина. 2012; 6: 95-101. [Zuyev V.M., Aleksandrov M.T., Khomeriki T.A., Tchernyshov G., Metreveli B.G., Popov S.N., Iboyan I.I., Kalinina E.A. Clinical value of laser conversion testing in diagnostics and treatment of a chronic endometritis. RUDN Journal of Medicine. 2012; (6): 95-101. (in Russian)].
  25. Осипова А.Д., Зуев В.М., Александров М.Т. Значение экспресс-метода лазерной конверсионной диагностики (раман-флуоресцентной составляющей) патологических процессов эндометрия у женщин в перименопаузе. Архив акушерства и гинекологии им. В.Ф. Снегирева. 2019; 6(2): 85-9. [Osipova A.D., Zuyev V.M., Aleksandrov M.T. The value of the express method of laser conversion diagnostics (raman-fluorescent component) of the pathological processes of endometrium in women in the perimenopause. V.F. Snegirev Archives of Obstetrics and Gynecology. 2019; 6(2): 85-9. (in Russian)]. http://dx.doi.org/10.18821/2313-8726-2019-6-2-85-89.
  26. Суханов А.А., Дикке Г.Б. Дефект имплантации эмбриона. Положительный прогноз – залог успешного ЭКО. Акушерство и гинекология сегодня. 2023; 4: 10-1. [Sukhanov A.A., Dikke G.B. Embryo implantation defect. A positive prognosis is the key to successful IVF. Obstetrics and Gynaecology Today. 2023; 4: 10-1. (in Russian)]. https://medvedomosti.media/articles/defekt-implantatsii-yaytsekletki-polozhitelnyy-prognoz-zalog-uspeshnogo-eko/
  27. Дикке Г.Б., Суханов А.А., Кукарская И.И., Остроменский В.В. Способ прогнозирования рецидива бактериального вагиноза у женщин, инфицированных герпес-вирусами. Патент на изобретение RU №2810428 от 27.12.2023. Опубликовано 27.12.2023, Бюл. № 36. [Dikke G.B., Sukhanov A.A., Kukarskaya I.I., Ostromensky V.V. A method for predicting recurrence of bacterial vaginosis in women infected with herpes viruses. Patent RU No.2810428 of 27.12.2023. Publ. 27.12.2023, Bul. No. 36. (in Russian)].

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