Hum. Reprod. Advance Access originally published online on September 22, 2006
Human Reproduction 2007 22(2):536-542; doi:10.1093/humrep/del378
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Pregnancy is predictable: a large-scale prospective external validation of the prediction of spontaneous pregnancy in subfertile couples*
1 Department of Public Health, Erasmus MC, University Medical Center, Rotterdam 2 Center for Reproductive Medicine, Academic Medical Center, Amsterdam 3 Department of Obstetrics & Gynaecology, Vrije Universiteit Medical Center, Amsterdam 4 Division of Reproductive Medicine, Department of Perinatology and Gynaecology, University Medical Center, Utrecht 5 Department of Obstetrics & Gynaecology, TweeSteden Ziekenhuis, Tilburg 6 Department of Clinical Epidemiology and Biostatistics, Academic Medical Center and 7 Department of Obstetrics & Gynaecology, Máxima Medical Center, Veldhoven, The Netherlands
8 To whom correspondence should be addressed at: Academic Medical Center, Center of Reproductive Medicine, Room H4-213, Department of Obstetrics/Gynaecology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands. E-mail: j.w.vandersteeg{at}amc.uva.nl
BACKGROUND: Prediction models for spontaneous pregnancy may be useful tools to select subfertile couples that have good fertility prospects and should therefore be counselled for expectant management. We assessed the accuracy of a recently published prediction model for spontaneous pregnancy in a large prospective validation study. METHODS: In 38 centres, we studied a consecutive cohort of subfertile couples, referred for an infertility work-up. Patients had a regular menstrual cycle, patent tubes and a total motile sperm count (TMC) >3 x 106. After the infertility work-up had been completed, we used a prediction model to calculate the chance of a spontaneous ongoing pregnancy (www.freya.nl/probability.php). The primary end-point was time until the occurrence of a spontaneous ongoing pregnancy within 1 year. The performance of the pregnancy prediction model was assessed with calibration, which is the comparison of predicted and observed ongoing pregnancy rates for groups of patients and discrimination. RESULTS: We included 3021 couples of whom 543 (18%) had a spontaneous ongoing pregnancy, 57 (2%) a non-successful pregnancy, 1316 (44%) started treatment, 825 (27%) neither started treatment nor became pregnant and 280 (9%) were lost to follow-up. Calibration of the prediction model was almost perfect. In the 977 couples (32%) with a calculated probability between 30 and 40%, the observed cumulative pregnancy rate at 12 months was 30%, and in 611 couples (20%) with a probability of 
40%, this was 46%. The discriminative capacity was similar to the one in which the model was developed (c-statistic 0.59). CONCLUSIONS: As the chance of a spontaneous ongoing pregnancy among subfertile couples can be accurately calculated, this prediction model can be used as an essential tool for clinical decision-making and in counselling patients. The use of the prediction model may help to prevent unnecessary treatment.
Key words: model/spontaneous pregnancy/prognosis/subfertility
* Presented as an oral presentation at the 21st Annual Meeting of the European Society of Human Reproduction & Embryology & ESHRE 2005, Copenhagen, Denmark.
CECERM study group (Collaborative Effort for Clinical Evaluation in Reproductive Medicine). Investigators, participating centres in the Netherlands: Y.M.van Kasteren, Alkmaar, Medisch Centrum Alkmaar; P.F.M.van der Heijden, Almelo, Twenteborg Ziekenhuis; W.A.Schöls, Amersfoort, Meander Medisch Centrum; M.H.Mochtar, Amsterdam, Academisch Medisch Centrum; G.L.M.Lips, Amsterdam, BovenIJ Ziekenhuis; J.Dawson, Amsterdam, St. Lucas Adreas Ziekenhuis; H.R.Verhoeve, Amsterdam, Onze Lieve Vrouwe Gasthuis; S.Milosavljevic, Amsterdam, Slotervaart Ziekenhuis; P.G.A.Hompes, Amsterdam, Vrij Universiteit Medisch Centrum; L.J.van Dam, Apeldoorn, Gelre Ziekenhuis; A.V.Sluijmer, Assen, Wilhelmina Ziekenhuis; H.E.Bobeck, Beverwijk, Rode Kruis Ziekenhuis; R.E.Bernardus, Blaricum, Ziekenhuis Gooi-Noord; M.C.S.Vermeer, Breda, Amphia Ziekenhuis Breda; J.P.Dörr, Den Haag, Medisch Centrum Haaglanden, Locatie Westeinde; P.J.Q.van der Linden, Deventer, Ziekenhuis Deventer; H.J.M.Roelofs, Dordrecht, A.Schweitzer Ziekenhuis; J.M.Burggraaff, Emmen, Scheper Ziekenhuis; G.J.E.Oosterhuis, Enschede, Medisch Spectrum Twente; M.H.Schouwink, Geldrop, St. Anna Ziekenhuis; P.X.J.M.Bouckaert, Heerlen, Atrium Medisch Centrum; F.M.C.Delemarre, Helmond, Elkerliek Ziekenhuis; C.J.C.M.Hamilton, ’s Hertogenbosch, Jeroen Bosch Ziekenhuis; M.van Hoven, Hilversum, Ziekenhuis Hilversum; M.H.Emanuel, Hoofddorp, Spaarne Ziekenhuis; C.N.M.Renckens, Hoorn, Westfries Gasthuis; J.A.Land, Maastricht, Academisch Ziekenhuis Maastricht; J.H.Schagen-Van Leeuwen, Nieuwegein, St. Antonius Ziekenhuis; J.A.M.Kremer, Nijmegen, UMC St. Radboud; C.van Katwijk, Purmerend, Waterland Ziekenhuis; M.H.A.van Hooff, Rotterdam, St. Franciscus Gasthuis; H.J.H.M.Van Dessel, Tilburg/Waalwijk, TweeSteden Ziekenhuis; F.J.M.Broekmans, Utrecht, UMC Utrecht; H.J.L.A.Ruis, Veghel, Ziekenhuis Bernhoven; C.A.M.Koks, Veldhoven, Máxima Medisch Centrum; P.Bourdrez, Venlo/Venray, Vie Curi Medisch Centrum; W.W.J.Riedijk, Zaandam, Zaans Medisch Centrum; B.J.Cohlen, Zwolle, Isala Klinieken.
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