Automated assessment of endometrial receptivity for screening recurrent pregnancy loss risk using deep learning-enhanced ultrasound and clinical data

Abstract

Background: Recurrent pregnancy loss (RPL) poses significant challenges in clinical management due to an unclear etiology in over half the cases. Traditional screening methods, including ultrasonographic evaluation of endometrial receptivity (ER), have been debated for their efficacy in identifying high-risk individuals. Despite the potential of artificial intelligence, notably deep learning (DL), to enhance medical imaging analysis, its application in ER assessment for RPL risk stratification remains underexplored.

Objective: This study aims to leverage DL techniques in the analysis of routine clinical and ultrasound examination data to refine ER assessment within RPL management.

Methods: Employing a retrospective, controlled design, this study included 346 individuals with unexplained RPL and 369 controls to assess ER. Participants were allocated into training (n = 485) and testing (n = 230) datasets for model construction and performance evaluation, respectively. DL techniques were applied to analyze conventional grayscale ultrasound images and clinical data, utilizing a pre-trained ResNet-50 model for imaging analysis and TabNet for tabular data interpretation. The model outputs were calibrated to generate probabilistic scores, representing the risk of RPL. Both comparative analyses and ablation studies were performed using ResNet-50, TabNet, and a combined fusion model. These were evaluated against other state-of-the-art DL and machine learning (ML) models, with the results validated against the testing dataset.

Results: The comparative analysis demonstrated that the ResNet-50 model outperformed other DL architectures, achieving the highest accuracy and the lowest Brier score. Similarly, the TabNet model exceeded the performance of traditional ML models. Ablation studies demonstrated that the fusion model, which integrates both data modalities and is presented through a nomogram, provided the most accurate predictions, with an area under the curve of 0.853. The radiological DL model made a more significant contribution to the overall performance of the fusion model, underscoring its superior predictive capability.

Conclusion: This investigation demonstrates the superiority of a DL-enhanced fusion model that integrates routine ultrasound and clinical data for accurate stratification of RPL risk, offering significant advancements over traditional methods.

Keywords: deep learning; endometrial receptivity; nomogram; recurrent pregnancy loss; routine examination; ultrasound.