Prognostische modellen in de voortplantingsgeneeskunde

A global fertility study in subfertile couples is used to make a diagnosis as well as to estimate a prognosis, i.e. the probability of a natural pregnancy without treatment. When is it advisable to decide to treat? What prospect is offered by which treatment? The answers to these questions should form the basis for advice and decision-making. There are models that predict the probability of pregnancy: some provide the possibility for a normal pregnancy for a couple, while others provide the likelihood of success with treatment such as IVF or ovulation induction. The estimate made by fertility experts for the probability of pregnancy without treatment appears to be reasonably reproducible, but there are significant differences in their estimate for the probability of success from IVF. Application of prognostic models has added value if a number of requirements are met (reliable and relevant for policy). For advice and decision-making in clinical practice, this particularly means that prediction among couples with a relatively low prospect of pregnancy must be accurate. The populations must be analogous. The Templeton model to predict the likelihood after IVF appears to satisfy the criteria for a Dutch population. Additional external validation of the prognostic models for the likelihood of natural pregnancy is desired.