Jones Christopher A, Christensen Anna L, Salihu Hamisu, Carpenter William, Petrozzino Jeffrey, Abrams Elizabeth, Sills Eric Scott, Keith Louis G
Center for Study of Multiple Birth; Chicago, IL USA.
J Exp Clin Assist Reprod. 2011;8:3. Epub 2011 Aug 12.
In vitro fertilization (IVF) has become a standard treatment for subfertility after it was demonstrated to be of value to humans in 1978. However, the introduction of IVF into mainstream clinical practice has been accompanied by concerns regarding the number of multiple gestations that it can produce, as multiple births present significant medical consequences to mothers and offspring. When considering IVF as a treatment modality, a balance must be set between the chance of having a live birth and the risk of having a multiple birth. As IVF is often a costly decision for patients-financially, medically, and emotionally-there is benefit from estimating a patient's specific chance that IVF could result in a birth as fertility treatment options are contemplated. Historically, a patient's "chance of success" with IVF has been approximated from institution-based statistics, rather than on the basis of any particular clinical parameter (except age). Furthermore, the likelihood of IVF resulting in a twin or triplet outcome must be acknowledged for each patient, given the known increased complications of multiple gestation and consequent increased risk of poor birth outcomes. In this research, we describe a multivariate risk assessment model that incorporates metrics adapted from a national 7.5-year sampling of the Human Fertilisation & Embryology Authority (HFEA) dataset (1991-1998) to predict reproductive outcome (including estimation of multiple birth) after IVF. To our knowledge, http://www.formyodds.com is the first Software-as-a-Service (SaaS) application to predict IVF outcome. The approach also includes a confirmation functionality, where clinicians can agree or disagree with the computer-generated outcome predictions. It is anticipated that the emergence of predictive tools will augment the reproductive endocrinology consultation, improve the medical informed consent process by tailoring the outcome assessment to each patient, and reduce the potential for adverse outcomes with IVF.
1978年体外受精（IVF）被证明对人类有价值后，已成为治疗生育力低下的标准方法。然而，将体外受精引入主流临床实践引发了人们对其所导致的多胎妊娠数量的担忧，因为多胎分娩会给母亲和后代带来重大医疗后果。在将体外受精作为一种治疗方式时，必须在活产几率和多胎分娩风险之间取得平衡。由于体外受精对患者来说往往在经济、医疗和情感上都是一项代价高昂的决定，因此在考虑生育治疗方案时，估计患者体外受精成功分娩的具体几率是有好处的。从历史上看，患者体外受精的“成功几率”是根据机构统计数据估算的，而不是基于任何特定的临床参数（年龄除外）。此外，鉴于已知多胎妊娠的并发症增加以及随之而来的不良分娩结局风险增加，必须为每位患者确认体外受精导致双胞胎或三胞胎结局的可能性。在本研究中，我们描述了一种多变量风险评估模型，该模型纳入了从人类受精与胚胎学管理局（HFEA）数据集（1991 - 1998年）的全国7.5年抽样中改编的指标，以预测体外受精后的生殖结局（包括多胎分娩的估计）。据我们所知，http://www.formyodds.com是第一个预测体外受精结局的软件即服务（SaaS）应用程序。该方法还包括一个确认功能，临床医生可以对计算机生成的结局预测表示同意或不同意。预计预测工具的出现将增强生殖内分泌咨询，通过为每位患者量身定制结局评估来改善医疗知情同意过程，并降低体外受精产生不良结局的可能性。
