Multivariate analyses on male factors and construction of a nomogram for predicting low in vitro fertilization rate

Abstract

Abstract Objective Low fertilization rate (LFR) and total fertilization failure (TFF) are often encountered in routine IVF procedure. To solve this problem, multivariate analyses on the relationship between male factors and in vitro fertilization rate were performed, and a nomogram for prediction of LFR was constructed. Methods This retrospective study contained 2,011 couples who received IVF treatment from January 2017 to December 2021. Man clinical characteristics, laboratory test results, in vitro fertilization rate were collected. Results A total of 2,011 couples underwent IVF were analyzed. Among these couples, 1,347 cases had in vitro fertilization rates ≥ 30% (control group), and 664 cases had in vitro fertilization rates < 30% (low fertilization rate (LFR) group). Univariate analyses of male factors found that between the two groups there were significant differences (p<0.05) in sperm progressive motility (SPR), sperm concentration (SC), total sperm number, normal sperm morphology rate (NSMR), DFI, sperm acrosin activity (SAA) and the clinical diagnosis of primary or secondary infertility, but not in blood glucose level, MBI, and semen volume. Multivariate logistic regression analyses showed that SPR, SAA, and SC were independent risk factors for LFR. An algorithm and a corespondent nomogram for predicting high LFR risk were constructed using data from the training cohort. The LFR nomogram exhibited an excellent discrimination power and a high fitting degree in both the training cohort (AUC = 0.90, 95% CI: 0.88 - 0.92), (H-L: x2 = 5.43, p = 0.71) and validation cohort (AUC = 0.89, 95% CI:0.87 - 0.92), (H-L: x2 = 7.85, p = 0.45), respectively. The decision curve analysis (DCA) demonstrated a high efficiency of the LFR nomogram for clinical utility. Conclusions SPR, SAA, and SC are independent risk factors for LFR. The LFR nomogram established based on these factors could be a useful tool to predict high risk of LFR, and patients with high risk of LFR can be guided to direct ICSI procedure. Clinical application of the LFR nomogram may increase the in vitro fertilization rate by facilitating the decision making in IVF service.