临床与病理杂志2025，Vol.45Issue(5)：568-580,13.DOI:10.11817/j.issn.2095-6959.2025.240671
不育男性辅助生殖助孕结局的影响因素及预测模型
Analysis of influencing factors and predictive model for assisted reproductive outcomes in infertile men
摘要
Abstract
Objective:Male fertility is closely influenced by various factors.Given the high cost and psychological burden of in vitro fertilization,it is crucial to investigate factors associated with assisted reproductive outcomes in infertile men.This study aims to explore the risk factors affecting reproductive outcomes in infertile men undergoing assisted reproductive treatment and to establish a predictive model for clinical pregnancy outcomes. Methods:A convenience sampling approach was used to recruit 1 037 infertile men who underwent intracytoplasmic sperm injection-embryo transfer(ICSI-ET)at the Reproductive Medicine Center,Obstetrics and Gynecology Hospital Affiliated to Tongji University,between March 2023 to September 2023.Participants completed demographic questionnaires,the Self-Rating Anxiety Scale(SAS),Self-Rating Depression Scale(SDS),Chinese Version of the Perceived Stress Scale(CPSS),and Athens Insomnia Scale(AIS).Semen,endocrine,and hematological data were collected through the hospital information system.The primary outcome was whether clinical pregnancy was achieved in a single treatment cycle.Participants were divided into a clinical pregnancy group(observation group)and a non-pregnancy group(control group),and differences in personal and laboratory factors were compared.Logistic regression was used to identify risk factors for clinical pregnancy,and a predictive nomogram was constructed using statistically significant variables.The model's performance was evaluated using receiver operating characteristic(ROC)curves,area under the curve(AUC),the Hosmer-Lemeshow test,accuracy,sensitivity,and specificity. Results:Clinical pregnancy was achieved in the partners of 403(38.86%)infertile men.Binary Logistic regression identified 12 independent risk factors for clinical pregnancy outcomes,including age,body mass index(BMI),smoking,alcohol use,daily sleep duration,daily physical activity duration,anxiety,depression,insomnia,progressive sperm motility,sperm DNA fragmentation index,and sperm viability(all P<0.05).The nomogram model constructed from these factors showed strong predictive performance with an AUC of 0.975,Hosmer-Lemeshow P=0.946,accuracy=0.894,sensitivity=0.913,and specificity=0.884. Conclusion:The outcome of assisted reproduction in infertile men is influenced by multiple factors,particularly sperm quality and lifestyle.The predictive model developed in this study demonstrates high accuracy and can assist clinicians in making proactive plans to improve sperm quality,alleviate negative emotions,and modify lifestyle habits,ultimately enhancing the success of assisted reproductive technologies.关键词
不育男性/辅助生殖/列线图模型/危险因素/临床妊娠/精子质量/生活方式/焦虑抑郁Key words
male infertility/assisted reproduction/nomogram model/risk factors/clinical pregnancy/sperm quality/lifestyle/anxiety and depression引用本文复制引用
王珂,徐燕,白洁,黄鑫,李哲芫,秦宁馨..不育男性辅助生殖助孕结局的影响因素及预测模型[J].临床与病理杂志,2025,45(5):568-580,13.基金项目
国家自然科学基金(82201882 （）
82271632) （）
上海市自然科学基金(23ZR1450200) （23ZR1450200）
同济大学附属妇产科医院护理专项课题(2023HL20).This work was supported by the National Natural Science Foundation(82201882 （2023HL20）
82271632),the Shanghai Natural Science Foundation(23ZR1450200) （23ZR1450200）
and the Nursing Special Project of Tongji University Affiliated Obstetrics and Gynecology Hospital(2023HL20),China. （2023HL20）
