Personalized prediction of first-cycle in vitro fertilization success.

OBJECTIVE: To test whether the probability of having a live birth (LB) with the first IVF cycle (C1) can be predicted and personalized for patients in diverse environments. DESIGN: Retrospective validation of multicenter prediction model. SETTING: Three university-affiliated outpatient IVF clinics located in different countries. PATIENT(S): Using primary models aggregated from >13,000 C1s, we applied the boosted tree method to train a preIVF-diversity model (PreIVF-D) with 1,061 C1s from 2008 to 2009, and validated predicted LB probabilities with an independent dataset comprising 1,058 C1s from 2008 to 2009. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Predictive power, reclassification, receiver operator characteristic analysis, calibration, dynamic range. RESULT(S): Overall, with PreIVF-D, 86% of cases had significantly different LB probabilities compared with age control, and more than one-half had higher LB probabilities. Specifically, 42% of patients could have been identified by PreIVF-D to have a personalized predicted success rate >45%, whereas an age-control model could not differentiate them from others. Furthermore, PreIVF-D showed improved predictive power, with 36% improved log-likelihood (or 9.0-fold by log-scale; >1,000-fold linear scale), and prediction errors for subgroups ranged from 0.9% to 3.7%. CONCLUSION(S): Validated prediction of personalized LB probabilities from diverse multiple sources identify excellent prognoses in more than one-half of patients.

Predicting personalized multiple birth risks after in vitro fertilization-double embryo transfer.

OBJECTIVE: To report and evaluate the performance and utility of an approach to predicting IVF-double embryo transfer (DET) multiple birth risks that is evidence-based, clinic-specific, and considers each patient's clinical profile. DESIGN: Retrospective prediction modeling. SETTING: An outpatient university-affiliated IVF clinic. PATIENT(S): We used boosted tree methods to analyze 2,413 independent IVF-DET treatment cycles that resulted in live births. The IVF cycles were retrieved from a database that comprised more than 33,000 IVF cycles. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): The performance of this prediction model, MBP-BIVF, was validated by an independent data set, to evaluate predictive power, discrimination, dynamic range, and reclassification. RESULT(S): Multiple birth probabilities ranging from 11.8% to 54.8% were predicted by the model and were significantly different from control predictions in more than half of the patients. The prediction model showed an improvement of 146% in predictive power and 16.0% in discrimination over control. The population standard error was 1.8%. CONCLUSION(S): We showed that IVF patients have inherently different risks of multiple birth, even when DET is specified, and this risk can be predicted before ET. The use of clinic-specific prediction models provides an evidence-based and personalized method to counsel patients.

Techniques for removal of the Essure hysteroscopic tubal occlusion device.

OBJECTIVE: To present two case reports of techniques for removal of the Essure (Conceptus, Inc., Mountain View, CA) hysteroscopic tubal occlusion device. DESIGN: Case report. SETTING: University-affiliated teaching hospital. PATIENT(S): Two women requesting removal of Essure devices because of persistent pelvic pain up to 6 weeks after placement. INTERVENTION(S): Hysteroscopic and laparoscopic removal of the Essure microinserts. No institutional review board approval was obtained because the procedures were not part of a study protocol. MAIN OUTCOME MEASURE(S): Effective removal of the Essure device and resolution of pelvic pain symptoms. RESULT(S): Successful removal of the device was achieved in both patients. In one case, the procedure was performed entirely by hysteroscopy. In the other case, a laparoscopic approach was required because of a lack of visualization of the device. Pain symptoms resolved within 2 weeks of removal in both patients. CONCLUSION(S): These are the first reported cases of successful removal of the Essure tubal occlusion devices up to 6 weeks after placement. This procedure can be safely performed with the use of hysteroscopy if the inserts are clearly visualized. Laparoscopy is an alternative when the device is completely within the fallopian tube. Further study is needed to assess the functionality of the tube after the procedure, as well as feasibility of removal beyond 6 weeks.