van der Steeg Jan W, Steures Pieternel, Eijkemans Marinus J C, Habbema J Dik F, Bossuyt Patrick M M, Hompes Peter G A, van der Veen Fulco, Mol Ben W J
Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, The Netherlands.
Reprod Biomed Online. 2006 Apr;12(4):473-80. doi: 10.1016/s1472-6483(10)62001-9.
Sixteen vignettes of subfertile couples were constructed by varying fertility history, post-coital test, sperm motility, FSH concentration and Chlamydia antibody titre (CAT). Thirty-five gynaecologists estimated probabilities of treatment-independent pregnancy, intrauterine insemination (IUI) and IVF. Thereafter, they chose IUI, IVF or no treatment. The relative contribution of each factor to probability estimates and to subsequent treatment decisions was calculated. Duration of subfertility and maternal age were the most important contributors for gynaecologists' estimates of treatment-independent pregnancy [relative contribution (RC) 41, 26%]. Maternal age and FSH concentration were the most important contributors in the estimates for IUI (RC: 51, 25%) and for IVF (RC: 64, 31%). The decision to start IVF was mainly determined by maternal age, duration of subfertility, FSH concentration and CAT. The relative contribution of maternal age and duration of subfertility was in concordance with existing prediction models, whereas previous pregnancy and FSH concentration were under- and overestimated respectively. In conclusion, maternal age, duration of subfertility and FSH concentration are the main factors in clinical decision-making in subfertility. Gynaecologists overestimate the importance of FSH concentration, but underestimate that of a previous pregnancy, as compared with their importance reported in prediction models and guidelines.
通过改变生育史、性交后试验、精子活力、促卵泡激素（FSH）浓度和衣原体抗体滴度（CAT），构建了16个不育夫妇的病例 vignettes。35名妇科医生估计了自然受孕、宫内人工授精（IUI）和体外受精（IVF）的概率。此后，他们选择IUI、IVF或不进行治疗。计算了每个因素对概率估计和后续治疗决策的相对贡献。不育持续时间和母亲年龄是妇科医生估计自然受孕概率的最重要因素[相对贡献（RC）分别为41、26%]。母亲年龄和FSH浓度是IUI概率估计（RC：51、25%）和IVF概率估计（RC：64、31%）中最重要的因素。开始IVF治疗的决定主要由母亲年龄、不育持续时间、FSH浓度和CAT决定。母亲年龄和不育持续时间的相对贡献与现有的预测模型一致，而既往妊娠和FSH浓度分别被低估和高估。总之，母亲年龄、不育持续时间和FSH浓度是不育临床决策的主要因素。与预测模型和指南中报告的重要性相比，妇科医生高估了FSH浓度的重要性，但低估了既往妊娠的重要性。
