Human Reproduction Update Advance Access published online on May 12, 2009
Human Reproduction Update, doi:10.1093/humupd/dmp013
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Prediction models in reproductive medicine: a critical appraisal
1 Department of Obstetrics and Gynecology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands 2 Department of Obstetrics/Gynaecology, Center for Reproductive Medicine, Academic Medical Center, Room H4-238, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands 3 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, Amsterdam, The Netherlands 4 Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
To whom correspondence should be addressed at: 5 Correspondence address. Tel: +31-20-5663456; Fax: +31-20-6963489; E-mail: e.leushuis{at}amc.uva.nl
BACKGROUND: Prediction models have been developed in reproductive medicine to help assess the chances of a treatment-(in)dependent pregnancy. Careful evaluation is needed before these models can be implemented in clinical practice.
METHODS: We systematically searched the literature for papers reporting prediction models in reproductive medicine for three strategies: expectant management, intrauterine insemination (IUI) or in vitro fertilization (IVF). We evaluated which phases of development these models had passed, distinguishing between (i) model derivation, (ii) internal and/or external validation, and (iii) impact analysis. We summarized their performance at external validation in terms of discrimination and calibration.
RESULTS: We identified 36 papers reporting on 29 prediction models. There were 9 models for the prediction of treatment-independent pregnancy, 3 for the prediction of pregnancy after IUI and 17 for the prediction of pregnancy after IVF. All of the models had completed the phase of model derivation. For six models, the validity of the model was assessed only in the population in which it was developed (internal validation). For eight models, the validity was assessed in populations other than the one in which the model was developed (external validation), and only three of these showed good performance. One model had reached the phase of impact analysis.
CONCLUSIONS: Currently, there are three models with good predictive performance. These models can be used reliably as a guide for making decisions about fertility treatment, in patients similar to the development population. The effects of using these models in patient care have to be further investigated.
Key words: prediction model / fertility / pregnancy / spontaneous pregnancy / ART (IUI/IVF)
Abstract presented at the 24th Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) in Barcelona, Spain (6–9 July 2008). Received on December 18, 2008; revised March 23, 2009; accepted on March 31, 2009