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New Decision-Tree Model for Defining the Risk of Reproductive Failure



Silvia Sánchez-Ramón, Division of Clinical Immunology, Department of Immunology, Hospital General Universitario Gregorio Marañón, Calle Doctor Esquerdo 46, 2007 Madrid, Spain.




Natural killer (NK) cells play a key role in embryo implantation and pregnancy success, whereas blood and uterine NK expansions have been involved in the pathophysiology of reproductive failure (RF). Our main goal was to design in a large observational study a tree-model decision for interpretation of risk factors for RF.

Methods of study

A hierarchical multivariate decision model based on a classification and regression tree was developed. NK and NKT-like cell subsets were analyzed by flow cytometry.


By multivariate analysis, blood NK cells expansion was an independent risk factor for RF (both recurrent miscarriages and implantation failures). We propose a new decision-tree model for the risk interpretation of women with RF based on a combination of main risk factors.


Women with age above 35 years and >13% CD56+CD16+ NK cells showed the highest risk of further pregnancy loss (100%).