Objective To develop a prognostic model for the outcome of IUI. Desig n Retrosp ective cohort study. Setting Four fertility centers in The Netherlands. Patient( s) Couples of whom the female partners had a regular cyc...Objective To develop a prognostic model for the outcome of IUI. Desig n Retrosp ective cohort study. Setting Four fertility centers in The Netherlands. Patient( s) Couples of whom the female partners had a regular cycle and who had been trea ted with IUI. Intervention(s) Intrauterine insemination with and without ovarian hyperstimulation. Main outcome measure(s)-Ongoing pregnancy. Result(s) Overall , 3,371 couples were included who underwent 14,968 cycles. There were 1,229 (8.2 %) pregnancies, of which 1,000 (6.7%) pregnancies were ongoing. Logistic regre ssion analysis demonstrated that increasing maternal age, longer duration of sub fertility, presence of male factor subfertility, one-sided tubal pathology, end ometriosis, uterine anomalies, and an increasing number of cycles were unfavorable predictors for an ongoing pregnancy. Cervical factor and the use o f ovarian hyperstimulation were favorable predictors. The area under the receive r operating characteristic curvewas 0.59. When couples were divided into four ca tegories based on prognosis, the difference between the predicted and observed c hance, that is, the calibration, was less than 0.5%in each of the four groups. Conclusion(s) Although our model had a relatively poor discriminative capacity, data on calibration showed that the selected prognostic factors allow distinctio n between couples with a poor prognosis and couples with a good prognosis. After external validation, this model could be of use in patient counseling and clini cal decision making.展开更多
Objective To determine what percentage of women can be given individu alized co unseling based on genetic information, as single nucleotide polymorphisms (SNPs) are associated with risks and benefits of estrogen thera...Objective To determine what percentage of women can be given individu alized co unseling based on genetic information, as single nucleotide polymorphisms (SNPs) are associated with risks and benefits of estrogen therapy and hormone therapy such as thrombosis, myocardial infarction, breast cancer, and bone protection. D esign Cross-sectional study. Setting Academic research institution. Patient(s) A consecutive series of 2,507 perimenopausal and postmenopausal women. Intervent ion(s) Peripheral venous puncture and multiplex polymerase chain reaction on a m icroarray system. Main outcome measure(s) Analysis of 22 SNPs of 17 genes: AGTMe t235Thr, APOECys112Arg, APOEArg158-Cys, COMTVal158Met, CYP17-34T >C, CYP191558 C >T, CYP19Arg264Cys, CYP1A16235T >C, CYP1A1Ile462Val, CYP1B1Leu432Val, CYP1B1A -sn453Ser, HSD17B1-27A >C, ER-αIVS-401T >C, prothrombin20210G >A, factor V Leiden, eNOS-786T >C, eNOSGlu298Asp, MRSer810L eu, MTHFR677C >T, PAI 15G >4G, SRD5A2Val89Leu, and VDRb >B. Result(s) Among the women in the study, 66%had at least two homozygous mutant SNPs of interest. A t hrombophilic disposition was found in 9.9%of women, and 23%of women had at lea st two SNPs associated with an increased risk of breast cancer (COMT, CYP17, CYP 19, CYP1A1, and CYP1B1). The SNPs predisposing women to cardiovascular pathologi es (e.g., APOE, AGT, eNOS, and PAI 1) were found in 12.3%of women. Carriage of SNPs predisposing to early postmenopausal bone loss and osteoporosis (ER-αand VDR) were found in 26.7%of women. Conclusion( s) These data suggest that the as sessment of SNPs associated with risks and benefits of estrogen/hormone therapy may be a new means to individualize counseling about and prescription of estroge n/hormone therapy in up to 66%of women.展开更多
文摘Objective To develop a prognostic model for the outcome of IUI. Desig n Retrosp ective cohort study. Setting Four fertility centers in The Netherlands. Patient( s) Couples of whom the female partners had a regular cycle and who had been trea ted with IUI. Intervention(s) Intrauterine insemination with and without ovarian hyperstimulation. Main outcome measure(s)-Ongoing pregnancy. Result(s) Overall , 3,371 couples were included who underwent 14,968 cycles. There were 1,229 (8.2 %) pregnancies, of which 1,000 (6.7%) pregnancies were ongoing. Logistic regre ssion analysis demonstrated that increasing maternal age, longer duration of sub fertility, presence of male factor subfertility, one-sided tubal pathology, end ometriosis, uterine anomalies, and an increasing number of cycles were unfavorable predictors for an ongoing pregnancy. Cervical factor and the use o f ovarian hyperstimulation were favorable predictors. The area under the receive r operating characteristic curvewas 0.59. When couples were divided into four ca tegories based on prognosis, the difference between the predicted and observed c hance, that is, the calibration, was less than 0.5%in each of the four groups. Conclusion(s) Although our model had a relatively poor discriminative capacity, data on calibration showed that the selected prognostic factors allow distinctio n between couples with a poor prognosis and couples with a good prognosis. After external validation, this model could be of use in patient counseling and clini cal decision making.
文摘Objective To determine what percentage of women can be given individu alized co unseling based on genetic information, as single nucleotide polymorphisms (SNPs) are associated with risks and benefits of estrogen therapy and hormone therapy such as thrombosis, myocardial infarction, breast cancer, and bone protection. D esign Cross-sectional study. Setting Academic research institution. Patient(s) A consecutive series of 2,507 perimenopausal and postmenopausal women. Intervent ion(s) Peripheral venous puncture and multiplex polymerase chain reaction on a m icroarray system. Main outcome measure(s) Analysis of 22 SNPs of 17 genes: AGTMe t235Thr, APOECys112Arg, APOEArg158-Cys, COMTVal158Met, CYP17-34T >C, CYP191558 C >T, CYP19Arg264Cys, CYP1A16235T >C, CYP1A1Ile462Val, CYP1B1Leu432Val, CYP1B1A -sn453Ser, HSD17B1-27A >C, ER-αIVS-401T >C, prothrombin20210G >A, factor V Leiden, eNOS-786T >C, eNOSGlu298Asp, MRSer810L eu, MTHFR677C >T, PAI 15G >4G, SRD5A2Val89Leu, and VDRb >B. Result(s) Among the women in the study, 66%had at least two homozygous mutant SNPs of interest. A t hrombophilic disposition was found in 9.9%of women, and 23%of women had at lea st two SNPs associated with an increased risk of breast cancer (COMT, CYP17, CYP 19, CYP1A1, and CYP1B1). The SNPs predisposing women to cardiovascular pathologi es (e.g., APOE, AGT, eNOS, and PAI 1) were found in 12.3%of women. Carriage of SNPs predisposing to early postmenopausal bone loss and osteoporosis (ER-αand VDR) were found in 26.7%of women. Conclusion( s) These data suggest that the as sessment of SNPs associated with risks and benefits of estrogen/hormone therapy may be a new means to individualize counseling about and prescription of estroge n/hormone therapy in up to 66%of women.
