The value of coagulation index in thromboelastograph for predicting early pregnancy loss in IVF/ICSI cycles

Introduction : Early pregnancy loss (EPL) is common among couples undergoing assisted reproductive technology(ART) treatment. This study aimed to investigate whether thromboelastography parameters on the day of embryo transfer, either alone or in combination with other clinical parameters, could predict subsequent EPL in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles. Methods : This study included 463 women who underwent IVF/ICSI cycles at the reproductive medicine center from May 2024 to May 2025. All these women underwent thromboelastography (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 through the receiver operating characteristic (ROC) curve. Results : 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), expected 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 for CI in predicting EPL is 0.75. The AUC for all five factors combined was 0.672, with a sensitivity of 71.3% and a specificity of 43.4%, which was better than any single factor. Conclusion : In IVF/ICSI cycles, a CI > 0.75(on the day of embryo transfer)was significantly associated with increased risk of EPL.