Construct a clinical prediction model of cumulative live birth rate for IVF/ICSI in female patients of different ages.

Abstract: In order to determine the number of eggs to be retrieved to maximize live birth outcomes, this study aimed to develop a clinical prediction model that would identify important predictors of cumulative live birth rate after intracytoplasmic sperm injection or in vitro fertilization in women of different ages. A total of 374 infertile women undergoing assisted reproductive treatment at the First Affiliated Hospital of Anhui Medical University between December 2020 and December 2023 were included and categorized into three age groups: <35 years, 35-39 years, and 40 years or older. Clinical data, laboratory results, ovulation induction parameters, and pregnancy outcomes were examined. Least absolute shrinkage and selection operator regression was used for predictive modeling, and linear regression equations were used to measure the correlation between the probability of a live birth and the quantity of retrieved eggs. The number of metaphase II eggs and high-score blastocysts were found to be the most predictive factors in women under 35, with live birth probabilities of 99% after 15 eggs were recovered. The most predictive factors among women aged 35-39 were the number of follicles and metaphase II eggs. The live birth probability was 90% when 20 eggs were retrieved. A live birth was predicted by the quantity of retrieved oocytes only for women aged 40 years or older; retrieving 14 eggs resulted in a 50% chance of giving birth. The proposed model provides age-specific recommendations for egg retrieval to improve reproductive outcomes and reduce the risk of overstimulation.

Lay summary: In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are important medical options that help couples with infertility have children. However, many women now delay having children until later in life, which can make it more difficult to become pregnant even with these treatments. As women age, both the number and quality of their eggs decline, and their chances of a successful pregnancy decrease. This study aimed to help doctors better predict the chances of a successful birth from IVF or ICSI treatments by creating a clinical prediction model. In this study, we selected 374 women of different age groups who underwent IVF/ICSI and analyzed how different factors, such as age and the number of retrieved eggs, affected the chances of giving birth. For example, in women under 35 years old, retrieving ten eggs results in a live birth probability of over 50%, while retrieving 15 and 20 eggs increases that chance to 99% and nearly 100%, respectively. In women aged 35-39, the live birth rates are approximately 60-70% with 15 eggs, 90% with 20 eggs, and over 95% with 25 eggs. For women aged 40 or older, retrieving 14 eggs gives about a 50% chance of live birth. This model helps doctors personalize treatment plans based on a woman's age, improving the chance of success while minimizing risks such as overstimulation of the ovaries. The study found that age plays a major role; generally, younger women need fewer eggs to achieve a high chance of giving birth.