Establishing a predictive model for ectopic pregnancy risk following assisted reproductive technology

The risk of ectopic pregnancy (EP) is known to increase with assisted reproductive technology (ART), but the specific risk factors are unclear. We screened 6872 cycles for clinical data that met our study’s inclusion criteria and conducted univariate and multivariate analyses to identify factors associated with EP and develop a nomogram prediction model for its incidence. The multivariate analysis demonstrated that women with polycystic ovary syndrome (PCOS) have an over two-fold increased risk of EP (aOR = 2.07, 95% CI: 1.27–3.36, P = 0.004). Frozen embryo transfer can significantly reduce the risk of EP compared to fresh embryo transfer (aOR = 2.17, 95% CI: 1.62–2.91, P < 0.001). Male infertility factor was associated with a 1.4-fold increased risk of EP (aOR = 1.39, 95% CI: 1.05–1.85,P = 0.021). Each 1 mm increase in endometrial thickness (EMT) is associated with a 15% reduction in the odds of EP(aOR = 0.86, 95% CI: 0.77–0.93, P < 0.001). Women with EP history was associated with 1.4-fold increased risk of EP (aOR = 1.41, 95% CI: 1.01–1.97, P = 0.046). A nomographic prediction model was established based on the results above. The area under the curve (AUC) for the model predicting EP following ART is 0.624, whereas in the external validation set, it is 0.618. Our findings indicate that PCOS increases the risk of EP after ART, and fresh embryo transfer is also linked to higher EP rates. We developed a nomogram to predict and mitigate the incidence of EP. Retrospectively registered.