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Buisman ETIA, Grens H, Wang R, Bhattacharya S, Braat DDM, Huppelschoten AG, van der Steeg JW. OUP accepted manuscript. Hum Reprod Open 2022; 2022:hoac006. [PMID: 35224230 PMCID: PMC8868119 DOI: 10.1093/hropen/hoac006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
STUDY QUESTION What is the methodological validity and usefulness of randomized controlled trials (RCTs) on pain relief during oocyte retrieval for IVF and ICSI? SUMMARY ANSWER Key methodological characteristics such as randomization, allocation concealment, primary outcome measure and sample size calculation were inadequately reported in 33–43% of the included RCTs, and a broad heterogeneity is revealed in the studied outcome measures. WHAT IS KNOWN ALREADY A Cochrane review on conscious sedation and analgesia for women undergoing oocyte retrieval concluded that the overall quality of evidence was low or very low, mainly owing to poor reporting. This, and heterogeneity of studied outcome measures, limits generalizability and eligibility of results for meta-analysis. STUDY DESIGN, SIZE, DURATION For this review, a systematic search for RCTs on pain relief during oocyte retrieval was performed on 20 July 2020 in CENTRAL CRSO, MEDLINE, Embase, PsycINFO, CINAHL, ClinicalTrials.gov, WHO ICTRP, Web of Science, Portal Regional da BVS and Open Grey. PARTICIPANTS/MATERIALS, SETTING, METHODS RCTs with pain or patient satisfaction as an outcome were included and analysed on a set of methodological and clinical characteristics, to determine their validity and usefulness. MAIN RESULTS AND THE ROLE OF CHANCE Screening of 2531 articles led to an inclusion of 51 RCTs. Randomization was described inadequately in 33% of the RCTs. A low-risk method of allocation concealment was reported in 55% of the RCTs. Forty-nine percent of the RCTs reported blinding of participants, 33% of blinding personnel and 43% of blinding the outcome assessor. In 63% of the RCTs, the primary outcome was stated, but a sample size calculation was described in only 57%. Data were analysed according to the intention-to-treat principle in 73%. Treatment groups were not treated identically other than the intervention of interest in 10% of the RCTs. The primary outcome was intraoperative pain in 28%, and postoperative pain in 2%. The visual analogue scale (VAS) was the most used pain scale, in 69% of the RCTs in which pain was measured. Overall, nine other scales were used. Patient satisfaction was measured in 49% of the RCTs, for which 12 different methods were used. Occurrence of side-effects and complications were assessed in 77% and 49% of the RCTs: a definition for these was lacking in 13% and 20% of the RCTs, respectively. Pregnancy rate was reported in 55% of the RCTs and, of these, 75% did not adequately define pregnancy. To improve the quality of future research, we provide recommendations for the design of future trials. These include use of the VAS for pain measurement, use of validated questionnaires for measurement of patient satisfaction and the minimal clinically relevant difference to use for sample size calculations. LIMITATIONS, REASONS FOR CAUTION Consensus has not been reached on some methodological characteristics, for which we formulated recommendations. To prevent further heterogeneity in research on this topic, recommendations were formulated based on expert opinion, or on the most used method thus far. Future research may provide evidence to base new recommendations on. WIDER IMPLICATIONS OF THE FINDINGS Use of the recommendations given for design of trials on this topic can increase the generalizability of future research, increasing eligibility for meta-analyses and preventing wastefulness. STUDY FUNDING/COMPETING INTEREST(S) No specific funding was obtained for this study. S.B. reports being the editor-in-chief of Human Reproduction Open. For this manuscript, he was not involved with the handling process within Human Reproduction Open, or with the final decision. Furthermore, S.B. reports personal fees from Remuneration from Oxford University Press as editor-in-chief of Human Reproduction Open, personal fees from Editor and contributing author, Reproductive Medicine for the MRCOG, Cambridge University Press. The remaining authors declare no conflict of interest in relation to the work presented. TRIAL REGISTRATION NUMBER Not applicable.
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Affiliation(s)
- E T I A Buisman
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
- Correspondence address. Centre of Reproductive Medicine, Jeroen Bosch Hospital, Postbus 90153, 5200 ME ‘s-Hertogenbosch, Netherlands. E-mail: https://orcid.org/0000-0001-7857-5742
| | - H Grens
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands
| | - R Wang
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - S Bhattacharya
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Aberdeen, UK
| | - D D M Braat
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - A G Huppelschoten
- Department of Obstetrics and Gynaecology, Catharina Hospital, Eindhoven, The Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, ‘s-Hertogenbosch, The Netherlands
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Hamilton JAM, van der Steeg JW, Hamilton CJCM, de Bruin JP. A concise infertility work-up results in fewer pregnancies. Hum Reprod Open 2021; 2021:hoab033. [PMID: 34557598 PMCID: PMC8452484 DOI: 10.1093/hropen/hoab033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 08/09/2021] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION Is pregnancy success rate after a concise infertility work-up the same as pregnancy success rate after the traditional extensive infertility work-up? SUMMARY ANSWER The ongoing pregnancy rate within a follow-up of 1 year after a concise infertility work-up is significantly lower than the pregnancy success rate after the traditional and extensive infertility work-up. WHAT IS KNOWN ALREADY Based on cost-effectiveness studies, which have mainly focused on diagnosis, infertility work-up has become less comprehensive. Many centres have even adopted a one-stop approach to their infertility work-up. STUDY DESIGN SIZE DURATION We performed a historically controlled cohort study. In 2012 and 2013 all new infertile couples (n = 795) underwent an extensive infertility work-up (group A). In 2014 and 2015, all new infertile couples (n = 752) underwent a concise infertility work-up (group B). The follow-up period was 1 year for both groups. Complete follow-up was available for 99.0% of couples in group A and 97.5% in group B. PARTICIPANTS/MATERIALS SETTING METHODS The extensive infertility work-up consisted of history taking, a gynaecological ultrasound scan, semen analysis, ultrasonographic cycle monitoring, a timed postcoital test, a timed progesterone and chlamydia antibody titre. A hysterosalpingography (HSG) was advised routinely. The concise infertility work-up was mainly based on history taking, a gynaecological ultrasound scan and semen analysis. A HSG was only performed if tubal pathology was suspected or before the start of IUI. Laparoscopy and hormonal tests were only performed if indicated. Couples were treated according to the diagnosis with either expectant management (if the Hunault prognostic score was >30%), ovulation induction (in case of ovulation disorders), IUI in natural cycles (in case of cervical factor), IUI in stimulated cycles (if the Hunault prognostic score was <30%) or IVF/ICSI (in case of tubal factor, advanced female age, severe male factor and if other treatments remained unsuccessful). The primary outcomes were time to pregnancy and the ongoing pregnancy rates in both groups. The secondary outcomes were the number of investigations, the distribution of diagnoses made, the first treatment (started) after infertility work-up and the mode of conception. MAIN RESULTS AND THE ROLE OF CHANCE The descriptive data, such as age, duration of infertility, type of infertility and lifestyle habits, in both groups were comparable. In group A, more than twice the number of infertility investigations were performed, compared to group B. An HSG was made less frequently in group B (33% versus 42%) and at a later stage. A Kaplan-Meier curve shows a shorter time to pregnancy in group A. Also, a significantly higher overall ongoing pregnancy rate within a follow-up of 1 year was found in group A (58.7% versus 46.8%, respectively, P < 0.001). In group A, more couples conceived during the infertility work-up (14.7% versus 6.5%, respectively, P < 0.05). The diagnosis cervical infertility could only be made in group A (9.3%). The diagnosis unexplained infertility differed between groups, at 23.5% in group A and 32.2% in group B (P < 0.001). LIMITATIONS REASONS FOR CAUTION This was a historically controlled cohort study; introduction of bias cannot be ruled out. The follow-up rate was similar in the two groups and therefore could not explain the differences in pregnancy rate. WIDER IMPLICATIONS OF THE FINDINGS Re-introduction of an extensive infertility work-up should be considered as it may lead to higher ongoing pregnancy rates within a year. The therapeutic effects of HSG and timing of intercourse may improve the fertility chance. This finding should be verified in a randomized controlled trial. STUDY FUNDING/COMPETING INTERESTS No funding was obtained for this study. No conflicts of interest were declared. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J A M Hamilton
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - C J C M Hamilton
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - J P de Bruin
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
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McLernon DJ, Lee AJ, Maheshwari A, van Eekelen R, van Geloven N, Putter H, Eijkemans MJ, van der Steeg JW, van der Veen F, Steyerberg EW, Mol BW, Bhattacharya S. Predicting the chances of having a baby with or without treatment at different time points in couples with unexplained subfertility. Hum Reprod 2020; 34:1126-1138. [PMID: 31119290 DOI: 10.1093/humrep/dez049] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 03/17/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Can we develop a prediction model that can estimate the chances of conception leading to live birth with and without treatment at different points in time in couples with unexplained subfertility? SUMMARY ANSWER Yes, a dynamic model was developed that predicted the probability of conceiving under expectant management and following active treatments (in vitro fertilisation (IVF), intrauterine insemination with ovarian stimulation (IUI + SO), clomiphene) at different points in time since diagnosis. WHAT IS KNOWN ALREADY Couples with no identified cause for their subfertility continue to have a realistic chance of conceiving naturally, which makes it difficult for clinicians to decide when to intervene. Previous fertility prediction models have attempted to address this by separately estimating either the chances of natural conception or the chances of conception following certain treatments. These models only make predictions at a single point in time and are therefore inadequate for informing continued decision-making at subsequent consultations. STUDY DESIGN, SIZE, DURATION A population-based study of 1316 couples with unexplained subfertility attending a regional clinic between 1998 and 2011. PARTICIPANTS/MATERIALS, SETTING, METHODS A dynamic prediction model was developed that estimates the chances of conception within 6 months from the point when a diagnosis of unexplained subfertility was made. These predictions were recomputed each month to provide a dynamic assessment of the individualised chances of conception while taking account of treatment status in each month. Conception must have led to live birth and treatments included clomiphene, IUI + SO, and IVF. Predictions for natural conception were externally validated using a prospective cohort from The Netherlands. MAIN RESULTS AND THE ROLE OF CHANCE A total of 554 (42%) couples started fertility treatment within 2 years of their first fertility consultation. The natural conception leading to live birth rate was 0.24 natural conceptions per couple per year. Active treatment had a higher chance of conception compared to those who remained under expectant management. This association ranged from weak with clomiphene to strong with IVF [clomiphene, hazard ratio (HR) = 1.42 (95% confidence interval, 1.05 to 1.91); IUI + SO, HR = 2.90 (2.06 to 4.08); IVF, HR = 5.09 (4.04 to 6.40)]. Female age and duration of subfertility were significant predictors, without clear interaction with the relative effect of treatment. LIMITATIONS, REASONS FOR CAUTION We were unable to adjust for other potentially important predictors, e.g. measures of ovarian reserve, which were not available in the linked Grampian dataset that may have made predictions more specific. This study was conducted using single centre data meaning that it may not be generalizable to other centres. However, the model performed as well as previous models in reproductive medicine when externally validated using the Dutch cohort. WIDER IMPLICATIONS OF THE FINDINGS For the first time, it is possible to estimate the chances of conception following expectant management and different fertility treatments over time in couples with unexplained subfertility. This information will help inform couples and their clinicians of their likely chances of success, which may help manage expectations, not only at diagnostic workup completion but also throughout their fertility journey. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by a Chief Scientist Office postdoctoral training fellowship in health services research and health of the public research (ref PDF/12/06). B.W.M. is supported by an NHMRC Practitioner Fellowship (GNT1082548). B.W.M. reports consultancy for ObsEva, Merck, and Guerbet. None of the other authors declare any conflicts of interest.
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Affiliation(s)
- D J McLernon
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A J Lee
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - A Maheshwari
- Aberdeen Centre for Reproductive Medicine, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - R van Eekelen
- Centre for Reproductive Medicine, Academic Medical Centre, AZ Amsterdam, The Netherlands.,Department of Biostatistics and Research Support, University Medical Centre Utrecht-Julius Centre, GA Utrecht, The Netherlands
| | - N van Geloven
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - H Putter
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, The Netherlands
| | - M J Eijkemans
- Department of Biostatistics and Research Support, University Medical Centre Utrecht-Julius Centre, GA Utrecht, The Netherlands
| | - J W van der Steeg
- Department for Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, GZ 's-Hertogenbosch, The Netherlands
| | - F van der Veen
- Centre for Reproductive Medicine, Academic Medical Centre, AZ Amsterdam, The Netherlands
| | - E W Steyerberg
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, RC Leiden, The Netherlands.,Department of Public Health, Erasmus MC-University Medical Centre Rotterdam, CN Rotterdam, The Netherlands
| | - B W Mol
- The Robinson Institute-School of Medicine, University of Adelaide, Adelaide, Australia
| | - S Bhattacharya
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker W, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1578-1588. [PMID: 32353142 PMCID: PMC7368397 DOI: 10.1093/humrep/dez284] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/25/2022] Open
Abstract
STUDY QUESTION Does septum resection improve reproductive outcomes in women with a septate uterus? SUMMARY ANSWER In women with a septate uterus, septum resection does not increase live birth rate nor does it decrease the rates of pregnancy loss or preterm birth, compared with expectant management. WHAT IS KNOWN ALREADY The septate uterus is the most common uterine anomaly with an estimated prevalence of 0.2-2.3% in women of reproductive age, depending on the classification system. The definition of the septate uterus has been a long-lasting and ongoing subject of debate, and currently two classification systems are used worldwide. Women with a septate uterus may be at increased risk of subfertility, pregnancy loss, preterm birth and foetal malpresentation. Based on low quality evidence, current guidelines recommend removal of the intrauterine septum or, more cautiously, state that the procedure should be evaluated in future studies. STUDY DESIGN, SIZE, DURATION We performed an international multicentre cohort study in which we identified women mainly retrospectively by searching in electronic patient files, medical records and databases within the time frame of January 2000 until August 2018. Searching of the databases, files and records took place between January 2016 and July 2018. By doing so, we collected data on 257 women with a septate uterus in 21 centres in the Netherlands, USA and UK. PARTICIPANTS/MATERIALS, SETTING, METHODS We included women with a septate uterus, defined by the treating physician, according to the classification system at that time. The women were ascertained among those with a history of subfertility, pregnancy loss, preterm birth or foetal malpresentation or during a routine diagnostic procedure. Allocation to septum resection or expectant management was dependent on the reproductive history and severity of the disease. We excluded women who did not have a wish to conceive at time of diagnosis. The primary outcome was live birth. Secondary outcomes included pregnancy loss, preterm birth and foetal malpresentation. All conceptions during follow-up were registered but for the comparative analyses, only the first live birth or ongoing pregnancy was included. To evaluate differences in live birth and ongoing pregnancy, we used Cox proportional regression to calculate hazard rates (HRs) and 95% CI. To evaluate differences in pregnancy loss, preterm birth and foetal malpresentation, we used logistic regression to calculate odds ratios (OR) with corresponding 95% CI. We adjusted all reproductive outcomes for possible confounders. MAIN RESULTS AND THE ROLE OF CHANCE In total, 257 women were included in the cohort. Of these, 151 women underwent a septum resection and 106 women had expectant management. The median follow-up time was 46 months. During this time, live birth occurred in 80 women following a septum resection (53.0%) compared to 76 women following expectant management (71.7%) (HR 0.71 95% CI 0.49-1.02) and ongoing pregnancy occurred in 89 women who underwent septum resection (58.9%), compared to 80 women who had expectant management (75.5%) (HR 0.74 (95% CI 0.52-1.06)). Pregnancy loss occurred in 51 women who underwent septum resection (46.8%) versus 31 women who had expectant management (34.4%) (OR 1.58 (0.81-3.09)), while preterm birth occurred in 26 women who underwent septum resection (29.2%) versus 13 women who had expectant management (16.7%) (OR 1.26 (95% CI 0.52-3.04)) and foetal malpresentation occurred in 17 women who underwent septum resection (19.1%) versus 27 women who had expectant management (34.6%) (OR 0.56 (95% CI 0.24-1.33)). LIMITATIONS, REASONS FOR CAUTION Our retrospective study has a less robust design compared with a randomized controlled trial. Over the years, the ideas about the definition of the septate uterus has changed, but since the 257 women with a septate uterus included in this study had been diagnosed by their treating physician according to the leading classification system at that time, the data of this study reflect the daily practice of recent decades. Despite correcting for the most relevant patient characteristics, our estimates might not be free of residual confounding. WIDER IMPLICATIONS OF THE FINDINGS Our results suggest that septum resection, a procedure that is widely offered and associated with financial costs for society, healthcare systems or individuals, does not lead to improved reproductive outcomes compared to expectant management for women with a septate uterus. The results of this study need to be confirmed in randomized clinical trials. STUDY FUNDING/COMPETING INTEREST(S) A travel for JFWR to Chicago was supported by the Jo Kolk Studyfund. Otherwise, no specific funding was received for this study. The Department of Obstetrics and Gynaecology, University Medical Centre, Groningen, received an unrestricted educational grant from Ferring Pharmaceutical Company unrelated to the present study. BWM reports grants from NHMRC, personal fees from ObsEva, personal fees from Merck, personal fees from Guerbet, other payment from Guerbet and grants from Merck, outside the submitted work. The other authors declare no conficts of interest. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the Netherlands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women’s and Children’s Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker WKH, Jansen FW, van der Steeg JW, Janssen CAH, Kapiteijn K, Schols WA, Torrenga B, Torrance HL, Verhoeve HR, Huirne JAF, Hoek A, Nieboer TE, van Rooij IAJ, Clark TJ, Robinson L, Stephenson MD, Mol BWJ, van der Veen F, van Wely M, Goddijn M. Corrigendum. Septum resection in women with a septate uterus: a cohort study. Hum Reprod 2020; 35:1722. [PMID: 32472131 PMCID: PMC7368394 DOI: 10.1093/humrep/deaa141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 11/20/2019] [Accepted: 12/05/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- J F W Rikken
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - K W J Verhorstert
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M H Emanuel
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - M Y Bongers
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Eindhoven, the Netherlands
| | - T Spinder
- Department of Obstetrics and Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - W K H Kuchenbecker
- Department of Obstetrics and Gynaecology, Isala Hospital Zwolle, Zwolle, the Netherlands
| | - F W Jansen
- Department of Obstetrics and Gynaecology, University Medical Centre Leiden, Leiden, the Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Den Bosch, the Netherlands
| | - C A H Janssen
- Department of Obstetrics and Gynaecology, Groene Hart Hospital, Gouda, the Netherlands
| | - K Kapiteijn
- Department of Obstetrics and Gynaecology, Reinier de Graaf Gasthuis, Delft, the Netherlands
| | - W A Schols
- Department of Obstetrics and Gynaecology, Meander Medical Centre, Amersfoort, the Netherlands
| | - B Torrenga
- Department of Obstetrics and Gynaecology, Ikazia Hospital, Rotterdam, the Netherlands
| | - H L Torrance
- Department of Reproductive Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - H R Verhoeve
- Department of Obstetrics and Gynaecology, OLVG Oost, Amsterdam, the Netherlands
| | - J A F Huirne
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - A Hoek
- Department of Obstetrics and Gynaecology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - T E Nieboer
- Department of Obstetrics and Gynaecology, Nijmegen, the Netherlands
| | - I A J van Rooij
- Department of Obstetrics and Gynaecology, Elisabeth Hospital Tweesteden, Tilburg, the NetherNetherlandslands
| | - T J Clark
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - L Robinson
- Department of Obstetrics and Gynaecology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - M D Stephenson
- Department of Obstetrics and Gynaecology, University of Illinois, CA, USA
| | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Monash Medical Centre, Clayton, Victoria, Australia
| | - F van der Veen
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M van Wely
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
| | - M Goddijn
- Centre for Reproductive Medicine and Department of Obstetrics and Gynaecology, Amsterdam University Medical Centre, Location AMC and VUMC, PO Box 22700, 1100 DE, Amsterdam, the Netherlands
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Pleunis N, Breunis WB, Merks JHM, Bouwma AE, van der Steeg JW. [A toddler with a vaginal mass and blood loss; the rhabdomyosarcoma]. Ned Tijdschr Geneeskd 2017; 161:D1674. [PMID: 28914211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The differential diagnosis of vaginal blood loss in childhood is broad, and includes irritation of the mucous membranes, trauma, tumours, foreign bodies and sexual abuse. Physical and additional examination is often initially difficult; however, prompt detection of a rhabdomyosarcoma, a soft-tissue tumour principally diagnosed in childhood, is vitally important. CASE DESCRIPTION A 3-year-old girl with a history of vaginal blood loss and an introital mass was referred to the gynaecologist. Treatment with oestriol and triamcinolone cream did not lead to healing. Pathological examination of a biopsy taken under general anaesthetic indicated an embryonic rhabdomyosarcoma. Chemotherapy, surgical resection and brachytherapy lead to persistent remission of the tumour. CONCLUSION Because rhabdomyosarcoma is rare and can present atypically, diagnosis can be delayed. Early recognition is, however, essential and this condition should be placed high in the differential diagnosis by vaginal blood loss or vaginal abnormality in childhood.
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Affiliation(s)
- N Pleunis
- Jeroen Bosch Ziekenhuis, afd. Obstetrie & Gynaecologie 's-Hertogenbosch
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van Eekelen R, Scholten I, Tjon-Kon-Fat RI, van der Steeg JW, Steures P, Hompes P, van Wely M, van der Veen F, Mol BW, Eijkemans MJ, Te Velde ER, van Geloven N. Natural conception: repeated predictions over time. Hum Reprod 2016; 32:346-353. [PMID: 27993999 DOI: 10.1093/humrep/dew309] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 10/24/2016] [Accepted: 11/09/2016] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION How can we predict chances of natural conception at various time points in couples diagnosed with unexplained subfertility? SUMMARY ANSWER We developed a dynamic prediction model that can make repeated predictions over time for couples with unexplained subfertility that underwent a fertility workup at a fertility clinic. WHAT IS KNOWN ALREADY The most frequently used prediction model for natural conception (the 'Hunault model') estimates the probability of natural conception only once per couple, that is, after completion of the fertility workup. This model cannot be used for a second or third time for couples who wish to know their renewed chances after a certain period of expectant management. STUDY DESIGN, SIZE, DURATION A prospective cohort studying the long-term follow-up of subfertile couples included in 38 centres in the Netherlands between January 2002 and February 2004. Couples with bilateral tubal occlusion, anovulation or a total motile sperm count <1 × 106 were excluded. PARTICIPANTS/MATERIALS, SETTING, METHODS The primary endpoint was time to natural conception, leading to an ongoing pregnancy. Follow-up time was censored at the start of treatment or at the last date of contact. In developing the new dynamic prediction model, we used the same predictors as the Hunault model, i.e. female age, duration of subfertility, female subfertility being primary or secondary, sperm motility and referral status. The performance of the model was evaluated in terms of calibration and discrimination. Additionally, we assessed the utility of the model in terms of the variability of the calculated predictions. MAIN RESULTS AND THE ROLE OF CHANCE Of the 4999 couples in the cohort, 1053 (21%) women reached a natural conception leading to an ongoing pregnancy within a mean follow-up of 8 months (5th and 95th percentile: 1-21). Our newly developed dynamic prediction model estimated the median probability of conceiving in the first year after the completion of the fertility workup at 27%. For couples not yet pregnant after half a year, after one year and after one and a half years of expectant management, the median probability of conceiving over the next year was estimated at 20, 15 and 13%, respectively. The model performed fair in an internal validation. The prediction ranges were sufficiently broad to aid in counselling couples for at least two years after their fertility workup. LIMITATIONS, REASONS FOR CAUTION The dynamic prediction model needs to be validated in an external population. WIDER IMPLICATIONS OF THE FINDINGS This dynamic prediction model allows reassessment of natural conception chances after various periods of unsuccessful expectant management. This gives valuable information to counsel couples with unexplained subfertility that are seen for a fertility workup. STUDY FUNDING/COMPETING INTERESTS This study was facilitated by grant 945/12/002 from ZonMW, The Netherlands Organization for Health Research and Development, The Hague, The Netherlands. No competing interests.
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Affiliation(s)
- R van Eekelen
- Academic Medical Center, Centre for Reproductive Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands .,Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Scholten
- Academic Medical Center, Centre for Reproductive Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - R I Tjon-Kon-Fat
- Academic Medical Center, Centre for Reproductive Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - J W van der Steeg
- Department of Obstetrics and Gynaecology, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, The Netherlands
| | - P Steures
- Department of Obstetrics and Gynaecology, St. Elisabeth Ziekenhuis, Tilburg, The Netherlands
| | - P Hompes
- Department of Obstetrics and Gynaecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
| | - M van Wely
- Academic Medical Center, Centre for Reproductive Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - F van der Veen
- Academic Medical Center, Centre for Reproductive Medicine, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - B W Mol
- The Robinson Institute-School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - M J Eijkemans
- Department of Biostatistics and Research Support, Julius Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E R Te Velde
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - N van Geloven
- Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, The Netherlands
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Tjon-Kon-Fat RI, Lar DN, Steyerberg EW, Broekmans FJ, Hompes P, Mol BWJ, Steures P, Bossuyt PMM, van der Veen F, van der Steeg JW, Eijkemans MJC. Inter-clinic variation in the chances of natural conception of subfertile couples. Hum Reprod 2013; 28:1391-7. [DOI: 10.1093/humrep/det063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Coppus SFPJ, Land JA, Opmeer BC, Steures P, Eijkemans MJC, Hompes PGA, Bossuyt PMM, van der Veen F, Mol BWJ, van der Steeg JW. Chlamydia trachomatis IgG seropositivity is associated with lower natural conception rates in ovulatory subfertile women without visible tubal pathology. Hum Reprod 2011; 26:3061-7. [DOI: 10.1093/humrep/der307] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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van den Boogaard NM, Oude Rengerink K, Steures P, Bossuyt PM, Hompes PGA, van der Veen F, Mol BWJ, van der Steeg JW. Tailored expectant management: risk factors for non-adherence. Hum Reprod 2011; 26:1784-9. [PMID: 21531998 DOI: 10.1093/humrep/der123] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Prediction models for spontaneous pregnancy are useful tools to prevent overtreatment, complications and costs in subfertile couples with a good prognosis. The use of such models and subsequent expectant management in couples with a good prognosis are recommended in the Dutch fertility guidelines, but not fully implemented. In this study, we assess risk factors for non-adherence to tailored expectant management. METHODS Couples with mild male, unexplained and cervical subfertility were included in this multicentre prospective cohort study. If the probability of spontaneous pregnancy within 12 months was ≥40%, expectant management for 6-12 months was advised. Multivariable logistic regression was used to identify patient and clinical characteristics associated with non-adherence to tailored expectant management. RESULTS We included 3021 couples of whom 1130 (38%) had a ≥40% probability of a spontaneous pregnancy. Follow-up was available for 1020 (90%) couples of whom 214 (21%) had started treatment between 6 and 12 months and 153 (15%) within 6 months. A higher female age and a longer duration of subfertility were associated with treatment within 6 months (OR: 1.06, 95% CI: 1.01-1.1; OR: 1.4; 95% CI: 1.1-1.8). A fertility doctor in a clinical team reduced the risk of treatment within 6 months (OR: 0.62; 95% CI: 0.39-0.99). CONCLUSIONS In couples with a favorable prognosis for spontaneous pregnancy, there is considerable overtreatment, especially if the woman is older and duration of the subfertility is longer. The presence of a fertility doctor in a clinic may prevent early treatment.
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Affiliation(s)
- N M van den Boogaard
- Centre for Reproductive Medicine, Academic Medical Center, Amsterdam, The Netherlands.
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Bensdorp AJ, Eijkemans MJC, Steures P, Habbema JDF, Hompes PGA, Bossuyt PMM, van der Veen F, Mol BWJ, Steeg JW, Broeze KA, Opmeer BC, Coppus SF, van Geloven N, den Hartog JE, Land JA, van der Linden PJQ, Ng EHY, van der Steeg JW, Steures P, van der Veen F, Mol BW, Ng EHY, So EWS, Li RHW, Yeung WSB, Ho PC, Hart R, Doherty DA, Newnham IA, Pennell CE, Newnham JP, Jo Varghese S, Engman M, Brett G, Gemzell K, Lalitkumar PGL. SELECTED ORAL COMMUNICATION SESSION, SESSION 47: FROM DIAGNOSIS TO TREATMENT, Tuesday 5 July 2011 15:15 - 16:30. Hum Reprod 2011. [DOI: 10.1093/humrep/26.s1.47] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Verhoeve HR, Coppus SFPJ, van der Steeg JW, Steures P, Hompes PGA, Bourdrez P, Bossuyt PMM, van der Veen F, Mol BWJ, van Kasteren YM, van der Heijden PFM, Schols WA, Mochtar MH, Lips GLM, Dawson J, Verhoeve HR, Milosavljevic S, Hompes PGA, van Dam LJ, Sluijmer AV, Bobeck HE, Bernardus RE, Vermeer MCS, Dorr JP, van der Linden PJQ, Roelofs HJM, Burggraaff JM, Oosterhuis GJE, Schouwink MH, Emanuel MH, Bouckaert PXJM, Delemarre FMC, Hamilton CJCM, van Hoven M, Renckens CM, Land JA, Schagen-van Leeuwen JH, Kremer JAM, van Katwijk C, van Hooff MHA, van Dessel HJHM, Broekmans FJM, Ruis HJLA, Koks CAM, Bourdrez P, Riedijk WWJ, Cohlen BJ. The capacity of hysterosalpingography and laparoscopy to predict natural conception. Hum Reprod 2010; 26:134-42. [DOI: 10.1093/humrep/deq263] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ocal P, Sahmay S, Irez T, Senol H, Cepni I, Purisa S, Lin W, Liu X, Donjacour A, Maltepe E, Rinaudo P, Baumgarten MN, Stoop D, Haentjes P, Verheyen G, De Schrijver F, Liebaers I, Camus M, Bonduelle M, Devroey P, Nelissen ECM, Van Montfoort APA, Coonen E, Derhaag JG, Evers JLH, Dumoulin JCM, Costa Lopes JR, Mendes dos Santos J, Portugal Silva Lima S, Portugal Silva Souza S, Rodrigues Pereira T, Barguil Brasileiro JP, Pina H, Lessa ML, Genovese Soares M, Medina Lopes V, Ribeiro CG, Adami K, Hughes C, Emerson G, Grundy K, Kelly P, Mocanu E, Rodrigues Pereira T, Medina Lopes V, Barguil Brasileiro JP, Coelho Cafe T, de Souza Costa JBM, Zavattiero Tierno NI, Portugal Silva Lima S, Portugal Silva Souza S, Mendes dos Santos J, Costa Lopes JR, Rinaudo P, Lin W, Liu X, Donjacour A, Singh S, Vitthala S, Zosmer A, Sabatini L, Tozer A, Davis C, Al-Shawaf T, Neri QV, Monahan D, Rosenwaks Z, Palermo GD, Kalu E, Thum MY, Abdalla HA, Sazonova A, Bergh C, Kallen K, Thurin-Kjellberg A, Wennerholm UB, Griesinger G, Doody K, Witjes H, Mannaerts B, Tarlatzis B, Witjes H, Mannaerts B, Rombauts L, Heijnen E, Marintcheva-Petrova M, Elbers J, Koning A, Mutsaerts MAQ, Hoek A, Mol BW, Fadini R, Guarnieri T, Mignini Renzini M, Comi R, Mastrolilli M, Villa A, Colpi E, Coticchio G, Dal Canto M, Dolleman M, Broer SL, Opmeer BC, Fauser BC, Mol BW, Broekmans FJM, Alama P, Requena A, Crespo J, Munoz M, Ballesteros A, Munoz E, Fernandez M, Meseguer M, Garcia-Velasco JA, Pellicer A, Munk M, Smidt-Jensen S, Blaabjerg J, Christoffersen C, Lenz S, Lindenberg S, Bosch E, Labarta E, Cruz F, Simon C, Remohi J, Pellicer A, Esler J, Osborn J, Boissonnas Chalas C, Marszalek A, Fauque P, Wolf JP, De Ziegler D, Cabanes L, Jouannet P, Han AR, Park CW, Cha SW, Kim HO, Yang KM, Kim JY, Song IO, Koong MK, Kang IS, Roszaman R, Omar MH, Nazri Y, Azantee YW, Murad AZ, Zainulrashid MR, Wang N, Le F, Wang LY, Ding GL, Sheng JZ, Huang HF, Jin F, Reinblatt S, Holzer H, Son WY, Shalom-Paz E, Chian RC, Buckett W, Dahan M, Demirtas E, Tan SL, Revel A, Schejter-Dinur Y, Revel-Vilk S, Hermens RPMG, van den Boogaard E, Leschot NJ, Vollebergh JHA, Bernardus R, Kremer JAM, van der Veen F, Goddijn M, Nahuis MJ, Kose N, Bayram N, Hompes PGA, Mol BWJ, van der veen F, van Wely M, Van Disseldorp J, Broer SL, Dolleman MD, Broeze K, Opmeer BC, Mol BW, Broekmans FJM, De Rycke M, Petrussa L, Liebaers I, Van de Velde H, Cerrillo M, Pacheco A, Rodriguez S, Gomez R, Delagado F, Pellicer A, Garcia Velasco JA, Desmyttere S, Verpoest W, De Rycke M, Staessen C, De Vos A, Liebaers I, Bonduelle M, Kohls G, Ruiz FJ, De la Fuente G, Toribio M, Martinez M, Pellicer A, Garcia-Velasco JA, Soderstrom - Anttila V, Salevaara M, Suikkari AM, Clua E, Tur R, Alcaniz N, Boada M, Rodriguez I, Barri PN, Veiga A, Nelen WLDM, Van Empel IWH, Cohlen BJ, Laven JS, Aarts JWM, Kremer JAM, Ricciarelli E, Gomez-Palomares JL, Andres-Criado L, Hernandez ER, Courbiere B, Aye M, Perrin J, Di Giorgio C, De Meo M, Botta A, Castilla Alcala J, Luceno Maestre F, Cabello Y, Gomez-Palomares JL, Hernandez J, Marqueta J, Pareja A, Hernandez E, Coroleu B, Helmgaard L, Klein BM, Arce JC, Aarts JWM, van Empel IWH, Boivin J, Kremer JAM, Verhaak CM, Ding G, Yin R, Wang N, Sheng J, Huang H, Mancini F, Tur R, Gomez MJ, Rodriguez I, Coroleu B, Barri PN, van den Boogaard NM, van der Steeg JW, van der Veen F, Hompes P, Mol BW, Boyer P, Gervoise-Boyer M, Meddeb L, Rossin B, Audibert F, Sakian S, Chan Wong E, Ma S, Pathak R, Mustafa MD, Ahmed RS, Tripathi AK, Guleria K, Banerjee BD, Vela G, Luna M, Flisser ED, Sandler B, Brodman M, Grunfeld L, Copperman AB, Baronio M, Carrascosa P, Capunay C, Vallejos J, Papier S, Borghi M, Sueldo C, Carrascosa J, Martin Lopez E, Marcucci A, Marcucci I, Salacone P, Sebastianelli A, Caponecchia L, Pacini N, Rago R, Alvarez M, Carreras O, Gomez MJ, Tur R, Coroleu B, Barri PN, Arnoldi M, Diaferia D, Corbucci MG, De Lauretis L, Kook MJ, Jung JY, Lee JH, Jung YJ, Hwang HK, Kang A, An SJ, Kim HM, Kwon HC, Lee SJ, Satoh M, Imada J, Ito K, Migishima F, Inoue T, Ohnishi Y, Kawato H, Nakaoka Y, Fukuda A, Morimoto Y, Mourad S, Hermens RPMG, Nelen WLDM, Grol RPTM, Kremer JAM, Polyzos NP, Valachis A, Patavoukas E, Papanikolaou EG, Messinis IE, Tarlatzis BC, Kang H, Kim CH, Park E, Kim S, Chae HD, Kang BM, Jung KS, Song HJ, Ahn YS, Petkova L, Canov I, Milachich T, Shterev A, Patrat C, Fauque P, Pocate K, Juillard JC, Gayet V, Blanchet V, de Ziegler D, Wolf JP, van der JW, Leushuis E, Steures P, Koks C, Oosterhuis J, Bourdrez P, Bossuyt PM, van der Veen F, Mol BWJ, Hompes PGA. Posters * Safety & Quality (I.E. Guidelines, Multiple Pregnancy, Outcome, Follow-Up etc.). Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Steures P, van der Steeg JW, Hompes PGA, Bossuyt PMM, van der Veen F, Habbema JDF, Eijkemans MJC, Broekmans FJ, Verhoeve HR, Mol BWJ. [Intra-uterine insemination with controlled ovarian hyperstimulation compared to an expectant management in couples with unexplained subfertility and an intermediate prognosis: a randomised study]. Ned Tijdschr Geneeskd 2008; 152:1525-1531. [PMID: 18681363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE Intrauterine insemination (IUI) with controlled ovarian hyperstimulation (COH) is commonly used as treatment of first choice in couples with unexplained subfertility. This treatment should only be applied when there is a realistic increase in chance of pregnancy, particularly because it carries the increased risk of multiple pregnancies. We evaluated the effectiveness of IUI with COH relative to expectant management in couples with unexplained subfertility and an intermediate prognosis of a spontaneous ongoing pregnancy. DESIGN Multicentre randomised clinical study. METHOD 253 couples with unexplained subfertility and a probability of a spontaneous ongoing pregnancy of 30% to 40% within 12 months, were randomly assigned to IUI with COH for 6 months or expectant management for 6 months. The primary endpoint of our study was ongoing pregnancy within 6 months. Analysis was carried out according to the intention to treat principle. This study was registered with the Dutch Trial Register and has the International Standard Randomised Clinical Trial number ISRCTN72675518. RESULTS Of the 253 couples included, 127 couples were allocated to IUI with COH and 126 to expectant management. In the intervention group, 42 women (33%) conceived, of which 29 pregnancies were ongoing (23%). In the expectant management group, 40 women (32%) conceived, of which 34 pregnancies were ongoing (27%) (relative risk: 0.85; 95% CI: 0.63-1.1). In the expectant management group one twin pregnancy occurred and in the intervention group one woman conceived twins and one a triplet. CONCLUSION A substantial beneficial effect of IUI with COH in couples with unexplained subfertility and an intermediate prognosis can be excluded. Expectant management for a period of 6 months therefore appears justified in these couples.
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Affiliation(s)
- P Steures
- Academisch Medisch Centrum/Universiteit van Amsterdam, Postbus 22.660, 1100 DD Amsterdam.
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van der Steeg JW, Steures P, Eijkemans MJ, Habbema JDF, Hompes PG, Burggraaff JM, Oosterhuis GJE, Bossuyt PM, van der Veen F, Mol BW. Obesity affects spontaneous pregnancy chances in subfertile, ovulatory women. Hum Reprod 2007; 23:324-8. [DOI: 10.1093/humrep/dem371] [Citation(s) in RCA: 321] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Coppus SFPJ, Verhoeve HR, Opmeer BC, van der Steeg JW, Steures P, Eijkemans MJC, Hompes PGA, Bossuyt PMM, van der Veen F, Mol BWJ. Identifying subfertile ovulatory women for timely tubal patency testing: a clinical decision rule based on medical history. Hum Reprod 2007; 22:2685-92. [PMID: 17675647 DOI: 10.1093/humrep/dem251] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of tubal testing is to identify women with bilateral tubal pathology in a timely manner, so they can be treated with IVF or tubal surgery. At present, it is unclear for which women early tubal testing is indicated, and in whom it can be deferred. METHODS Data on 3716 women who underwent tubal patency testing as a part of their routine fertility workup were used to relate elements in their medical history to the presence of tubal pathology. With multivariable logistic regression, we constructed two diagnostic models. One in which tubal disease was defined as occlusion and/or severe adhesions of at least one tube, whereas in a second model, tubal disease was defined as the presence of bilateral abnormalities. RESULTS Both models discriminated moderately well between women with and women without tubal disease with an area under the receiver-operating characteristic curve (AUC) of 0.65 (95% CI: 0.63-0.68) for any tubal pathology and 0.68 (95% CI: 0.65-0.71) for bilateral tubal pathology, respectively. However, the models could make an almost perfect distinction between women with a high and a low probability of tubal pathology. A decision rule in the form of a simple diagnostic score chart was developed for application of the models in clinical practice. CONCLUSIONS In conclusion, the present study provides two easy to use decision rules that can accurately express a woman's probability of (severe) tubal pathology at the couple's first consultation. They could be used to select women for tubal testing more efficiently.
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Affiliation(s)
- S F P J Coppus
- Centre for Reproductive Medicine, Department of Obstetrics and Gynaecology, Academic Medical Centre, Amsterdam, The Netherlands.
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van der Steeg JW, Steures P, Eijkemans MJC, Habbema JDF, Hompes PGA, Broekmans FJ, van Dessel HJHM, Bossuyt PMM, van der Veen F, Mol BWJ. Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples*. Hum Reprod 2006; 22:536-42. [PMID: 16997935 DOI: 10.1093/humrep/del378] [Citation(s) in RCA: 126] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prediction models for spontaneous pregnancy may be useful tools to select subfertile couples that have good fertility prospects and should therefore be counselled for expectant management. We assessed the accuracy of a recently published prediction model for spontaneous pregnancy in a large prospective validation study. METHODS In 38 centres, we studied a consecutive cohort of subfertile couples, referred for an infertility work-up. Patients had a regular menstrual cycle, patent tubes and a total motile sperm count (TMC) >3 x 10(6). After the infertility work-up had been completed, we used a prediction model to calculate the chance of a spontaneous ongoing pregnancy (www.freya.nl/probability.php). The primary end-point was time until the occurrence of a spontaneous ongoing pregnancy within 1 year. The performance of the pregnancy prediction model was assessed with calibration, which is the comparison of predicted and observed ongoing pregnancy rates for groups of patients and discrimination. RESULTS We included 3021 couples of whom 543 (18%) had a spontaneous ongoing pregnancy, 57 (2%) a non-successful pregnancy, 1316 (44%) started treatment, 825 (27%) neither started treatment nor became pregnant and 280 (9%) were lost to follow-up. Calibration of the prediction model was almost perfect. In the 977 couples (32%) with a calculated probability between 30 and 40%, the observed cumulative pregnancy rate at 12 months was 30%, and in 611 couples (20%) with a probability of >or=40%, this was 46%. The discriminative capacity was similar to the one in which the model was developed (c-statistic 0.59). CONCLUSIONS As the chance of a spontaneous ongoing pregnancy among subfertile couples can be accurately calculated, this prediction model can be used as an essential tool for clinical decision-making and in counselling patients. The use of the prediction model may help to prevent unnecessary treatment.
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Affiliation(s)
- J W van der Steeg
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
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van der Steeg JW, Steures P, Eijkemans MJC, Habbema JDF, Bossuyt PMM, Hompes PGA, van der Veen F, Mol BWJ. Do clinical prediction models improve concordance of treatment decisions in reproductive medicine? BJOG 2006; 113:825-31. [PMID: 16827767 DOI: 10.1111/j.1471-0528.2006.00992.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess whether the use of clinical prediction models improves concordance between gynaecologists with respect to treatment decisions in reproductive medicine. DESIGN We constructed 16 vignettes of subfertile couples by varying fertility history, postcoital test, sperm motility, follicle-stimulating hormone level and Chlamydia antibody titre. SETTING Thirty-five gynaecologists estimated three probabilities, i.e. the 1-year probability of spontaneous pregnancy, the pregnancy chance after intrauterine insemination (IUI) and the pregnancy chance after in vitro fertilisation (IVF). Subsequently they proposed therapeutic regimens for these 16 fictional couples, i.e. expectant management, IUI or IVF. Three months later, the participant gynaecologists again had to propose therapeutic regimes for the same 16 fictional cases but this time accompanied by pregnancy chances obtained from prediction models: predictions on spontaneous pregnancy, IUI and IVF. POPULATION Thirty-five gynaecologists working in academic and nonacademic hospitals in the Netherlands. METHODS Setting section. Main outcome measures The concordance between gynaecologists of probability estimates, expressed as interclass correlation coefficient (ICC) and the concordance between gynaecologists of treatment decisions, analysed by calculating Cohen's kappa (kappa). RESULTS The gynaecologists differed widely in estimating pregnancy chances (ICC: 0.34). Furthermore, there was a huge variation in the proposed therapeutic regimens (kappa: 0.21). The treatment decisions made by gynaecologists were consistent with the ranking of their probability estimates. When prediction models were used, the concordance (kappa) for treatment decisions increased from 0.21 to 0.38. The number of gynaecologists counselling for expectant management increased from 39 to 51%, whereas counselling for IVF dropped from 23 to 14%. CONCLUSION Gynaecologists differed widely in their estimation of prognosis in 16 fictional cases of subfertile couples. Their therapeutic regimens showed likewise huge variation. After confrontation with prediction models in the same 16 fictional cases, the proposed therapeutic regimens showed only slightly better concordance. Therefore a simple introduction of validated prediction models is insufficient to introduce concordant management between doctors.
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Affiliation(s)
- J W van der Steeg
- Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
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Steures P, van der Steeg JW, Hompes PGA, van der Veen F, Mol BWJ. [Results of intrauterine insemination in the Netherlands]. Ned Tijdschr Geneeskd 2006; 150:1127-33. [PMID: 16756226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE To assess the results of intrauterine insemination (IUI) in the Netherlands. DESIGN Retrospective. METHOD Based on annual reports and individual reports from gynaecologists, we calculated the number of registered IUI cycles performed, the pregnancy rates per cycle, the ongoing pregnancy rates per cycle and the multiple pregnancy rates per ongoing pregnancy in 2003. By extrapolating these results, we estimated the total number of IUI cycles performed in 2003 in the Netherlands and the related outcomes. These results were compared with IUI pregnancy rates from the international literature and Dutch national data on in vitro fertilisation (IVF). RESULTS In 2003, IUI was performed in 91 of the 101 hospitals in the Netherlands. Of these 91 hospitals, 58 (64%) registered their IUI results. These 58 hospitals performed 19,846 IUI cycles in 2003. The mean pregnancy rate per cycle was 9.0% and the ongoing pregnancy rate per cycle was 7.3%. Multiple pregnancies occurred in 9.5% of ongoing pregnancies. Extrapolation of the data of these 58 hospitals revealed that approximately 28,500 IUI cycles were performed in the Netherlands in 2003, of which approximately 2,000 resulted in an ongoing pregnancy. The number of multiple pregnancies following IUI was estimated to be 180 (9.0%). In the international literature, a pregnancy rate per cycle of 8.7% has been reported. According to the national IVF registry, 9,761 IVF cycles were started in 2003, resulting in 2,028 ongoing pregnancies (20.8% per cycle) and 439 twin pregnancies (21.6% per ongoing pregnancy). CONCLUSION The pregnancy rate per IUI cycle in the Netherlands (9.0%) was comparable to that reported in the international literature (8.7%). The contribution of IUI to the number of multiple pregnancies in the Netherlands was much smaller than the contribution of IVF.
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Affiliation(s)
- P Steures
- VU Medisch Centrum, afd Verloskunde en Gynaecologie, Amsterdam.
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Graziosi GCM, van der Steeg JW, Reuwer PHW, Drogtrop AP, Bruinse HW, Mol BWJ. Economic evaluation of misoprostol in the treatment of early pregnancy failure compared to curettage after an expectant management. Hum Reprod 2004; 20:1067-71. [PMID: 15618248 DOI: 10.1093/humrep/deh709] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The increased pressure on health care expenses implies that physicians should consider economic aspects as part of the clinical decision-making process. Direct and indirect costs of a strategy starting with misoprostol in treatment of early pregnancy failure as compared to curettage is therefore performed. METHODS We performed a cost-minimization analysis alongside a multicentre randomized trial. Clinical data and data on the use of medical resources were obtained from a randomized trial comparing misoprostol and curettage, which had shown that misoprostol reduced the need for curettage in 53%. In a sensitivity analysis the percentage of women who needed curettage after misoprostol varied between 25 and 90%. RESULTS Direct costs per case were significantly lower in the misoprostol group (mean 433) than in the curettage group (mean 683) (mean difference 250, 95% CI 184 to 316, P < 0.001). These significant differences existed under a wide range of alternative assumptions about unit costs. The differences in direct cost in favour of misoprostol were large for women who had complete evacuation after initial misoprostol treatment as compared to those who needed additional curettage after failed misoprostol. Mean indirect costs were equal for both groups (misoprostol mean 486; curettage mean 428; mean difference 60, 95% CI -61 to 179, P = 0.51). The mean total costs for a strategy starting with misoprostol was 915 versus 1107 for curettage, with a mean difference between both groups of 192 (95% CI 33 to 351, P = 0.04). An increase of the complete evacuation rates for initial misoprostol therapy to 90% in the sensitivity analysis increased the cost difference between misoprostol and curettage to 550. CONCLUSION The use of misoprostol for early pregnancy failure after failed expectant management is less costly than curettage.
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Affiliation(s)
- G C M Graziosi
- Department of Obstetrics and Gynaecology, St Antonius Hospital, Koekoekslaan 1, Nieuwegein, The Netherlands.
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van der Steeg JW, Steures P, te Velde ER, Hompes PGA, Mol BWJ. Treatment strategies for subfertile couples. Hum Reprod 2004; 19:1678; author reply 1678-9. [PMID: 15220308 DOI: 10.1093/humrep/deh271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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