Predicting the outcomes of assisted reproductive technology treatments: a systematic review and quality assessment of prediction models

Review Article

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VOLUME 2, ISSUE 1, P1-10, JANUARY 01, 2021

Authors:

Ian Henderson, M.Sc., Michael P. Rimmer, M.Sc., Stephen D. Keay, M.D., Paul Sutcliffe, Ph.D., Khalid S. Khan, M.Sc., Ephia Yasmin, Ph.D., Bassel H. Al Wattar, Ph.D. 

Abstract:

Objective

Predicting the outcomes of assisted reproductive technology (ART) treatments is desirable, but adopting prediction models into clinical practice remains limited. We aimed to review available prediction models for ART treatments by conducting a systematic review of the literature to identify the best-performing models for their accuracy, generalizability, and applicability.


Evidence review

We searched electronic databases (MEDLINE, EMBASE, and CENTRAL) until June 2020. We included studies reporting on the development or evaluation of models predicting the reproductive outcomes before (pre-ART) or after (intra-ART) starting treatment in couples undergoing any ART treatment. We evaluated the models’ discrimination, calibration, type of validation, and any implementation tools for clinical practice.


Results

We included 69 cohort studies reporting on 120 unique prediction models. Half of the studies reported on pre-ART (48%) and half on intra-ART (56%) prediction models. The commonest predictors used were maternal age (90%), tubal factor subfertility (50%), and embryo quality (60%). Only 14 models were externally validated (14/120, 12%), including 8 pre-ART models (Templeton, Nelson, LaMarca, McLernon, Arvis, and the Stolwijk A/I, C, II models) and 5 intra-ART models (Cai, Hunault, van Loendersloot, Meijerink, Stolwijk B, and the McLernon posttreatment model), with a reported c-statistic ranging from 0.50 to 0.78. Ten of these models provided implementation tools for clinical practice, with only 2 reporting online calculators.


Conclusion

We identified externally validated prediction models that could be used to advise couples undergoing ART treatments on their reproductive outcomes. The quality of the available models remains limited and more research is needed to improve their generalizability and applicability into clinical practice.

Fertility and Sterility

Editorial Office, American Society for Reproductive Medicine

Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.