The value of coagulation index in thromboelastography for predicting early pregnancy loss in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles

This study investigated whether thromboelastography (TEG) parameters on the day of embryo transfer, alone or combined with other clinical indicators, could predict early pregnancy loss in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles. This study included 463 women who underwent IVF/ICSI cycles at the reproductive medicine center from May 2024 to May 2025. According to the occurrence of early pregnancy loss (EPL), the participants were divided into the EPL group and the non-EPL group (129 vs. 334). All these women underwent TEG on the day of embryo transfer, and their pregnancy outcomes were continuously followed up. For risk variables, we performed LASSO analysis. To analyze the risk factors associated with EPL, we employed univariate and multivariate logistic regression analyses. A nomogram was constructed for risk scoring and prediction. The area under the curve (AUC) was compared among different factors using the receiver operating characteristic (ROC) curve. Among 463 women with clinical pregnancy, 129 (27.86%) experienced early pregnancy loss (< 12 weeks). There were significant differences in reaction time (R time), maximum amplitude (MA), estimated percent lysis, and coagulation index (CI) between women in the EPL group and those in the non-EPL group (P < 0.05). Multivariate logistic regression analysis showed that parity (OR = 1.614, 95% CI 1.004–2.571), thyroid and endocrine disorders (OR = 2.202, 95% CI 1.152–4.167), ovulatory dysfunction (OR = 4.408, 95% CI 1.992–10.01), and CI (OR = 1.222, 95% CI 1.077–1.397) were influencing factors for EPL in IVF/ICSI cycles. ROC curve analysis demonstrated that the optimal cutoff value of CI for predicting EPL was 0.75. The AUC for the combination of all five factors was 0.672, with a sensitivity of 71.3%, a specificity of 43.4%, a positive predictive value (PPV) of 32.73%, and a negative predictive value (NPV) of 79.66%, which was better than that of any single factor. CI on the day of embryo transfer is a valuable predictor for early pregnancy loss in women undergoing IVF/ICSI. However, this single-center study with a moderate sample size has some limitations.