{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T16:01:14Z","timestamp":1753891274182,"version":"3.41.2"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T00:00:00Z","timestamp":1750982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Predicting clinical pregnancy outcomes in patients with diminished ovarian reserve (DOR) undergoing <jats:italic>in vitro<\/jats:italic> fertilization\/intracytoplasmic sperm injection (IVF\/ICSI) remains challenging owing to the unique characteristics of this patient group. Therefore, this study aimed to leverage existing predictive models for pregnancy outcomes while integrating innovative strategies to develop and validate a visualization-based predictive model specifically designed for patients with DOR undergoing IVF\/ICSI treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This retrospective study analyzed data from 448 patients with DOR who underwent IVF\/ICSI at Guangxi Zhuang Autonomous Region Reproductive Hospital from January 2019 to August 2023. We developed and internally validated a nomogram incorporating the ovarian sensitivity index (OSI), age, and controlled ovarian hyperstimulation (COH) protocol to predict clinical pregnancy outcomes. Receiver operating characteristic (ROC) analysis, univariate and least absolute shrinkage and selection operator (LASSO) regression analyses, and multivariate logistic regression were used to construct the model. The optimal cut-off value of the OSI for predicting clinical pregnancy was 1.135.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Through multivariate analysis, age, OSI, and COH protocol were identified as independent predictors. The developed nomogram demonstrated good discrimination with an area under the ROC curve of 0.744, along with satisfactory calibration and clinical utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The developed nomogram can accurately predict clinical pregnancy outcomes in patients with DOR undergoing IVF\/ICSI, potentially assisting clinicians in personalized counselling and improving outcomes in this challenging patient population.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1618552","type":"journal-article","created":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:32:46Z","timestamp":1751002366000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Ovarian sensitivity index-based nomogram for predicting clinical pregnancy outcomes in patients with diminished ovarian reserve undergoing in vitro fertilization or intracytoplasmic sperm injection"],"prefix":"10.3389","volume":"12","author":[{"given":"Feng-Xia","family":"Liu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ka-Li","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shan-Jia","family":"Yi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hui","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ming-Hua","family":"Shi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xue-Fei","family":"Liang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1007\/s10815-017-1058-4","article-title":"Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR","volume":"35","author":"Pastore","year":"2018","journal-title":"J Assist Reprod Genet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1151","DOI":"10.1016\/j.fertnstert.2020.09.134","article-title":"Testing and interpreting measures of ovarian reserve: a committee opinion","volume":"114","year":"2020","journal-title":"Fertil Steril"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e35476","DOI":"10.7759\/cureus.35476","article-title":"Serum and follicular fluid thiol\/disulfide homeostasis in diminished ovarian reserve patients undergoing in vitro fertilization\/intracytoplasmic sperm injection treatment","volume":"15","author":"Erdo\u011fan","year":"2023","journal-title":"Cureus"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13048-023-01158-6","article-title":"Diminished ovarian reserve may not be associated with a poorer fresh cycle outcome in women <38 years","volume":"16","author":"Jin","year":"2023","journal-title":"J Ovarian Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.rbmo.2020.12.005","article-title":"Maternal age affects the relationship of basal FSH and anti-M\u00fcllerian hormone concentrations with post-ICSI\/IVF live birth","volume":"42","author":"Buratini","year":"2021","journal-title":"Reprod Biomed Online"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"202","DOI":"10.1038\/s41366-021-00978-0","article-title":"Impact of body mass index (BMI) on the success rate of fresh embryo transfer in women undergoing first in vitro fertilization\/intracytoplasmic sperm injection (IVF\/ICSI) treatment","volume":"46","author":"Chen","year":"2022","journal-title":"Int J Obes"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1851","DOI":"10.1007\/s11517-022-02569-1","article-title":"Predicting in vitro fertilization success in the Brazilian public health system: a machine learning approach","volume":"60","author":"Barreto","year":"2022","journal-title":"Med Biol Eng Comput"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1998","DOI":"10.1093\/humrep\/dead165","article-title":"External validation of models for predicting cumulative live birth over multiple complete cycles of IVF treatment","volume":"38","author":"Ratna","year":"2023","journal-title":"Hum Reprod"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"18331","DOI":"10.18632\/aging.203282","article-title":"Prediction of pregnancy outcome in fresh in vitro fertilization\/intracytoplasmic sperm injection treatment in patients with poor ovarian reserve","volume":"13","author":"Chen","year":"2021","journal-title":"Aging (Albany NY)"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"557","DOI":"10.1017\/S0967199423000382","article-title":"Evaluative effectiveness of follicular output rate, ovarian sensitivity index, and ovarian response prediction index for the ovarian reserve and response of low-prognosis patients according to the POSEIDON criteria: a retrospective study","volume":"31","author":"Chen","year":"2023","journal-title":"Zygote"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1747","DOI":"10.1007\/s43032-024-01469-z","article-title":"Predictive factors for the formation of viable embryos in subfertile patients with diminished ovarian reserve: a clinical prediction study","volume":"31","author":"Feng","year":"2024","journal-title":"Reprod Sci"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1186\/s12905-024-03039-6","article-title":"Effect of diminished ovarian reserve on the outcome of fresh embryo transfer in IVF\/ICSI cycles among young women: a retrospective cohort study","volume":"24","author":"Zhu","year":"2024","journal-title":"BMC Womens Health"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1086924","DOI":"10.3389\/fendo.2023.1086924","article-title":"Assisted reproductive technology and interactions between serum basal FSH\/LH and ovarian sensitivity index","volume":"14","author":"He","year":"2023","journal-title":"Front Endocrinol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1914","DOI":"10.3390\/jcm9061914","article-title":"The ovarian sensitivity index (OSI) significantly correlates with ovarian reserve biomarkers, is more predictive of clinical pregnancy than the total number of oocytes, and is consistent in consecutive IVF cycles","volume":"9","author":"Revelli","year":"2020","journal-title":"J Clin Med"},{"volume-title":"Advanced assisted reproduction techniques","year":"2005","author":"Zhuang","key":"ref15"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"307","DOI":"10.1097\/00001703-199906000-00013","article-title":"Culture and transfer of human blastocysts","volume":"11","author":"Gardner","year":"1999","journal-title":"Curr Opin Obstet Gynecol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"hoaa049","DOI":"10.1093\/hropen\/hoaa049","article-title":"The ovarian sensitivity index is predictive of live birth chances after IVF in infertile patients","volume":"2020","author":"Weghofer","year":"2020","journal-title":"Hum Reprod Open"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"458","DOI":"10.3389\/fendo.2020.00458","article-title":"Assisted Reproductive Technology in China: Results Generated From Data Reporting System by CSRM From 2013 to 2016","volume":"11","author":"Hu","year":"2020","journal-title":"Front Endocrinol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/S0140-6736(03)15268-3","article-title":"Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies","volume":"363","year":"2004","journal-title":"Lancet"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"125","DOI":"10.1080\/09513590.2017.1369515","article-title":"Characterization of a suboptimal IVF population and clinical outcome after two IVF cycles","volume":"34","author":"Alvaro Mercadal","year":"2018","journal-title":"Gynecol Endocrinol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.3906\/sag-1811-175","article-title":"The impact of different etiologies of diminished ovarian reserve on pregnancy outcome in IVF-ET cycles","volume":"49","author":"\u00d6zel\u00e7i","year":"2019","journal-title":"Turk J Med Sci"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"CD012693","DOI":"10.1002\/14651858.CD012693.pub2","article-title":"Individualised gonadotropin dose selection using markers of ovarian reserve for women undergoing in vitro fertilisation plus intracytoplasmic sperm injection (IVF\/ICSI)","volume":"2018","author":"Lensen","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"124","DOI":"10.1093\/humupd\/dmt037","article-title":"Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice","volume":"20","author":"La Marca","year":"2014","journal-title":"Hum Reprod Update"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"3361","DOI":"10.1210\/clinem\/dgaa513","article-title":"Anti-M\u00fcllerian hormone and ovarian reserve: update on assessing ovarian function","volume":"105","author":"Moolhuijsen","year":"2020","journal-title":"J Clin Endocrinol Metab"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"796199","DOI":"10.3389\/fendo.2022.796199","article-title":"Which factors are associated with reproductive outcomes of DOR patients in ART cycles: an eight-year retrospective study","volume":"13","author":"Li","year":"2022","journal-title":"Front Endocrinol"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.gene.2017.08.028","article-title":"Leptin siRNA promotes ovarian granulosa cell apoptosis and affects steroidogenesis by increasing NPY2 receptor expression","volume":"633","author":"Ding","year":"2017","journal-title":"Gene"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1097\/GME.0000000000001116","article-title":"Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis","volume":"25","author":"Moslehi","year":"2018","journal-title":"Menopause"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"199","DOI":"10.1007\/s10815-013-0144-5","article-title":"Ovarian sensitivity index is a better measure of ovarian responsiveness to gonadotrophin stimulation than the number of oocytes during in-vitro fertilization treatment","volume":"31","author":"Li","year":"2014","journal-title":"J Assist Reprod Genet"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.3390\/jcm11082099","article-title":"Are there ovarian responsive indexes that predict cumulative live birth rates in women over 39 years?","volume":"11","author":"Cesarano","year":"2022","journal-title":"J Clin Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"1489","DOI":"10.1093\/humrep\/dey238","article-title":"Diminished ovarian reserve and poor response to stimulation in patients <38 years old: a quantitative but not qualitative reduction in performance","volume":"33","author":"Morin","year":"2018","journal-title":"Hum Reprod"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"300060520934656","DOI":"10.1177\/0300060520934656","article-title":"Comparative study of assisted reproductive outcomes between young patients with occult premature ovarian insufficiency and advanced-age patients","volume":"48","author":"Yao","year":"2020","journal-title":"J Int Med Res"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"7279","DOI":"10.12659\/MSM.910410","article-title":"Egg quality and pregnancy outcome in young infertile women with diminished ovarian reserve","volume":"24","author":"Chang","year":"2018","journal-title":"Med Sci Monit"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"2010","DOI":"10.1093\/humrep\/dey295","article-title":"Cumulative live birth rates and number of oocytes retrieved in women of advanced age. A single Centre analysis including 4500 women \u226538 years old","volume":"33","author":"Devesa","year":"2018","journal-title":"Hum Reprod"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e0207081","DOI":"10.1371\/journal.pone.0207081","article-title":"GnRH agonist long protocol versus GnRH antagonist protocol for various aged patients with diminished ovarian reserve: a retrospective study","volume":"13","author":"Huang","year":"2018","journal-title":"PLoS One"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1007\/s00404-020-05954-z","article-title":"Meta-analysis of GnRH-antagonists versus GnRH-agonists in poor responder protocols","volume":"304","author":"Papamentzelopoulou","year":"2021","journal-title":"Arch Gynecol Obstet"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1618552\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:32:47Z","timestamp":1751002367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1618552\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,27]]},"references-count":35,"alternative-id":["10.3389\/fmed.2025.1618552"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1618552","relation":{},"ISSN":["2296-858X"],"issn-type":[{"type":"electronic","value":"2296-858X"}],"subject":[],"published":{"date-parts":[[2025,6,27]]},"article-number":"1618552"}}