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Prognostic Models for Infertility Treatment Outcomes
- 1. Prognostic models in Infertility
- 2. Basic fertility work up referral gyn History Physical examination Cycle evaluation Ovulation Semen analysis ? PCT Tubal p atency : CAT HSG DLS FSH, E2 AFC
- 5. Evers JL, Lancet 2002 Infertility or subfertility?
- 11. Hunault et al. HR 2004 Prediction models for spontaneous pregnancy Eimers Collins Snick Hunault Female age + + - + Duration subfertility + + + + F.A. man Urethritis vg. man + - - - - - - - prim/ sec subfertility + + - + Anovulation - - + - Tubal pathology - + + - Semen-analysis + + - + Endometriosis - + - - PCT Referral status + - + +/- +
- 12. Calculation Prognosis P = 1-0,0166 EXP(-0,053* age -0,152* duration -0,447* prim/sec +0.0035* prog.mot -0,949* PCT -0,321* referral )
- 14. Calibration Synthesis model 10 groups of N~260 Van der Steeg HR 2007
- 15. http:// www.amc.nl/prognosticmodel http:// www.amc.nl/prognosticmodel
- 18. Protocols for IVF GnRH Antagonist Protocols GnRH Agonist Protocols 225 IU per day (150 IU Europe) Individualized Dosing of FSH/HMG 250 g per day antagonist Individualized Dosing of FSH/HMG GnRHa 1.0 mg per day up to 21 days 0.5 mg per day of GnRHa 225 IU per day (150 IU Europe) Day 6 of FSH/HMG Day of hCG Day 1 of FSH/HMG Day 6 of FSH/HMG Day of hCG 7 – 8 days after estimated ovulation Down regulation Day 2 or 3 of menses Day 1 FSH/HMG
- 30. IVF prediction models Prediction models Outcome Discrimination Calibration Templeton (1996) IVF 0.63 good
- 33. IVF prediction models Prediction models Outcome Discrimination Calibration Templeton (1996) IVF 0.63 good
- 34. Lintsen, A.M.E. et al. Hum. Reprod. 2007
- 38. IUI prediction model prediction models Outcome Discrimination Calibration Steures (2004) IUI 0.59 good
- 39. PICO Patient woman, 34 years, 2ys 1ry unexplained inf. Intervention IUI Comparison wait Outcome Pregnancy
- 42. -- delayed treatment -- early treatment RR: 1, 0 (CI: 0,86-1,2) N= 90 (71%) N= 90 (71%)
- 45. http:// www.amc.nl/prognosticmodel http:// www.amc.nl/prognosticmodel
- 47. Lintsen, A.M.E. et al. Hum. Reprod. 2007
- 48. Basics Clinical Expertise Prediction Model Patient Preferences
Notas del editor
- “ Explicit , judicious , and conscientious use of current best evidence from medical care research to make decisions about the medical care of individuals ” Clinical expertise IS important! Why? Experience with patients: improves efficiency of diagnosis and treatment Improves ability to determine applicability of research data to your patients Allows consideration of patient preferences EBM is the process of systematically finding the most recent applicable research, appraising its validity, and using it as the basis for clinical decisions. Clinical Expertise improves efficiency of Dx and Rx considers patient preferences Overestimates usefulness of therapy -placebo effect - loss to follow-up “ Have not all concerned physicians been doing this (EBM) for ages... ? The steps and recommendations of the EBM acolytes reek of obfuscations and platitudes.” WKC Morgan, London, Ontario Lancet , October 28, 1995