en تعیین عوامل مرتبط با تعداد تخمک‌های با مورفولوژی مناسب در زنان نابارور: یک مطالعه مقطعی Fertility & Infertility Original Article Original Article <div style="text-align: justify;"><span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مقدمه: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">ناباروری میلیون‌ها زوج را در سراسر جهان تحت تأثیر قرار می‌دهد. تعداد تخمک‌های طبیعی از نظر مورفولوژیکی (</span></span><span dir="LTR" style="font-size:10.0pt">MNO</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) یک عامل تعیین‌کننده کلیدی در موفقیت فناوری کمک باروری (</span></span><span dir="LTR" style="font-size:10.0pt">ART</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) است. شناسایی دقیق عوامل مؤثر به دلیل وجود صفرهای اضافی در داده‌های بالینی دنیای واقعی محدود است.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">هدف: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">این مطالعه با هدف شناسایی عوامل بالینی مرتبط با تعداد </span></span><span dir="LTR" style="font-size:10.0pt">MNO</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> و نشان دادن برتری مدل‌های آماری پیشرفته - رگرسیون پواسون با صفر انباشته (</span></span><span dir="LTR" style="font-size:10.0pt">ZIP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) و رگرسیون نیمه پارامتری دو جمله&shy;ای منفی با صفر انباشته (</span></span><span dir="LTR" style="font-size:10.0pt">SZINB</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) - در تجزیه و تحلیل داده‌های بالینی با کیفیت بالا با نسبت بالای صفر انجام شد.</span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">مواد و روش &shy;ها: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">در این مطالعه مقطعی، داده‌های ۹۵۰ زن نابارور که از ژانویه ۲۰۱۲ تا دسامبر ۲۰۱۳ به پژوهشگاه رویان در تهران، ایران، مراجعه کرده بودند، از پرونده‌های پزشکی آنها استخراج شد از رگرسیون </span></span><span dir="LTR" style="font-size:10.0pt">ZIP</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> و </span></span><span dir="LTR" style="font-size:10.0pt">SZINB</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> برای مدل‌سازی داده‌های شمارش با تعداد زیادی صفر استفاده شد.</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></span></span></span></span></span><br> <span style="font-size:12pt"><span style="text-justify:inter-ideograph"><span style="direction:rtl"><span style="unicode-bidi:embed"><span new="" roman="" style="font-family:" times=""><b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج: </span></span></b><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">سابقه جراحی تخمدان (045/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) و ناهنجاری‌های تخمدان (041/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) به طور قابل توجهی </span></span><span dir="LTR" style="font-size:10.0pt">MNO</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> را کاهش دادند. ارتباط معکوس غیرخطی با افزایش سن (038/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، افزایش نسبت </span></span><span dir="LTR" style="font-size:10.0pt">LH/FSH</span><span style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> (044/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، </span></span><span dir="LTR" style="font-size:10.0pt">TSH</span> <span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">(026/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، قند خون ناشتا (049/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">)، نمره هیرسوتیسم (049/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) و افزایش چرخه‌های</span></span><span dir="LTR" style="font-size:10.0pt">ART</span> <span style="font-size:11.0pt"><span b="" mitra="" style="font-family:">&nbsp;(037/0 </span></span><span lang="FA" style="font-size:10.0pt">= </span><span dir="LTR" style="font-size:10.0pt">p</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">) مشاهده شد. مدل </span></span><span dir="LTR" style="font-size:10.0pt">SZINB</span><span lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:"> بهترین برازش را ارائه داد و الگوهای غیرخطی پیچیده‌ای را که توسط مدل‌های خطی قابل تشخیص نبودند، آشکار کرد.</span></span><span dir="LTR" style="font-size:11.0pt"><span style="font-family:"Arial",sans-serif"></span></span></span></span></span></span></span><br> <b><span dir="RTL" lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتیجه&shy; گیری: </span></span></b><span dir="RTL" lang="FA" style="font-size:11.0pt"><span b="" mitra="" style="font-family:">نتایج این مطالعه درک ما از عوامل بالینی و هورمونی مؤثر بر مورفولوژی تخمک در زنان نابارور را افزایش می‌دهد و اهمیت استفاده از مدل‌های آماری غیرخطی پیشرفته را در تحقیقات پزشکی تولید&shy;مثل برجسته می‌کند.</span></span></div> <div style="text-align: justify;"><span style="font-family:Times New Roman;"><span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Background:</span></b><span style="font-size:12.0pt"> Infertility affects millions of couples worldwide. The number of morphologically normal oocytes (MNO) is a key determinant of assisted reproductive technology success. Accurate identification of influencing factors is limited by excess zeros in real-world clinical data.</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Objective:</span></b><span style="font-size:12.0pt"> This study aimed to identify clinical factors associated with MNO count and to demonstrate the superiority of advanced statistical models, zero-inflated Poisson and semiparametric zero-inflated negative binomial regression, in analyzing high-quality clinical data with a high proportion of zeros.</span></span></span><br> <span style="font-size:11pt"><span style="line-height:normal"><b><span style="font-size:12.0pt">Materials and Methods:</span></b> <span style="font-size:12.0pt">In this cross-sectional study, data of 950 infertile women who referred to the Royan Institute, Tehran, Iran, between January 2012 and December 2013 were extracted from their medical records.</span> <span style="font-size:12.0pt">Zero-inflated Poisson</span><span style="font-size:12.0pt"> and</span><span style="font-size:12.0pt"> semiparametric zero-inflated negative binomial regression models were used to count data with a large number of zeros. </span></span></span><br> <span style="font-size:11pt"><span style="line-height:107%"><b><span style="font-size:12.0pt"><span style="line-height:107%">Results:</span></span></b><span style="font-size:12.0pt"><span style="line-height:107%"> Ovarian surgery history (p = 0.045) and ovarian abnormalities (p = 0.041) significantly reduced MNO. Nonlinear inverse associations were observed with advancing age (p = 0.038), elevated </span></span>luteinizing hormone/follicle-stimulating hormone <span style="font-size:12.0pt"><span style="line-height:107%">ratio (p = 0.044), </span></span>thyroid-stimulating hormone <span style="font-size:12.0pt"><span style="line-height:107%">(p = 0.026), fasting blood sugar (p = 0.049), hirsutism score (p = 0.049), and increasing </span></span><span style="font-size:12.0pt"><span style="line-height:107%">assisted reproductive technology </span></span><span style="font-size:12.0pt"><span style="line-height:107%">cycles (p = 0.037). The </span></span><span style="font-size:12.0pt"><span style="line-height:107%">semiparametric</span></span><span style="font-size:12.0pt"><span style="line-height:107%"> model provided the best fit and revealed complex nonlinear patterns not detectable by linear models.</span></span><span style="font-family:"Times New Roman",serif"></span></span></span><br> <b><span style="font-size:12.0pt"><span style="line-height:107%">Conclusion:</span></span></b><span style="font-size:12.0pt"><span style="line-height:107%"> The results of this study </span></span><span style="font-size:12.0pt"><span style="line-height:107%">enhance our understanding of the clinical and hormonal factors influencing oocyte morphology in infertile women and highlight the importance of applying advanced nonlinear statistical models in reproductive medicine research.</span></span></span></div> تخمک‌ها, ناباروری, زنان, فناوری کمک باروری, تحلیل رگرسیون, مدل‌های آماری. Oocytes, Infertility, Female, Assisted reproductive technology, Regression analysis, Statistical models. 1007 1020 http://ijrm.ir/browse.php?a_code=A-10-3065-1&slc_lang=en&sid=1 Zahra Asadollahi asadollahi.zahra@gmail.com 0000-0002-1503-8373 No Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Azadeh Ghaheri ghaheri@royaninstitute.org 0000-0003-4530-4596 No Department of Basic and Population Based Studies in NCD, Reproductive Epidemiology Research Center, Royan Institute, ACECR, Tehran, Iran. Saiedeh Haji-Maghsoudi sa.maghsoudi@gmail.com 0000-0002-4335-5843 No Modeling in Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. AliAkbar Haghdoost ahaghdoost@gmail.com 0000-0003-4628-4849 No Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran. Mahnaz Ashrafi dr.mahnaz.ashrafi@gmail.com 0000-0002-7278-8509 No Department of Endocrinology and Female Infertility, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Poopak Eftekhari-Yazdi peyazdi50@gmail.com 0000-0003-0730-2530 No Department of Embryology, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran. Yunes Jahani yonesjahani@yahoo.com; u.jahani@kmu.ac.ir 0000-0002-6808-7101 Yes Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.