{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,7,2]],"date-time":"2024-07-02T12:30:31Z","timestamp":1719923431425},"reference-count":30,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,7,16]],"date-time":"2014-07-16T00:00:00Z","timestamp":1405468800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BJOG"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To assess by proof of principle whether the individual risk for preterm birth (<jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content>) should be incorporated into the embryo transfer policy in <jats:italic>in\u00a0vitro<\/jats:italic> fertilisation (<jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and setting<\/jats:title><jats:p>A theoretical decision analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and main outcome measures<\/jats:title><jats:p>A decision tree was built to compare the consequences of different chances of <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> on the outcome of single embryo transfer (<jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>) or double embryo transfer (<jats:styled-content style=\"fixed-case\">DET<\/jats:styled-content>) in patients with different prognosis of conception. Based on patient characteristics, three scenarios of prognosis of conception were considered and the consequences of <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">DET<\/jats:styled-content> were calculated for different chances of <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> in these groups. The primary outcome was the health of the children born. Sensitivity analyses were performed for both prognosis for conception and chances of <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In women with good fertility prospects, one <jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content> cycle with <jats:styled-content style=\"fixed-case\">DET<\/jats:styled-content> increases the ongoing pregnancy rate (<jats:styled-content style=\"fixed-case\">OPR<\/jats:styled-content>) from 29 to 39% compared with <jats:styled-content style=\"fixed-case\">SET<\/jats:styled-content>, whereas the chances of poor neonatal outcome in these extra pregnancies range from 1.4 to 11% per pregnancy depending on the individual <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> risk. However, for women with poor fertility prospects, <jats:styled-content style=\"fixed-case\">DET<\/jats:styled-content> increases the <jats:styled-content style=\"fixed-case\">OPR<\/jats:styled-content> from 8 to 11% with minimal additional poor neonatal outcome, ranging from 0.3 to 4.0% per pregnancy for women with a low or high <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> risk, respectively. Our findings were robust in multiple sensitivity analyses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In an <jats:styled-content style=\"fixed-case\">IVF<\/jats:styled-content> programme, the optimal embryo transfer strategy is dependent on the singleton and multiple pregnancy chances of a woman, but also on her <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> risk. In women with low <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content> risk, <jats:styled-content style=\"fixed-case\">DET<\/jats:styled-content> increases the <jats:styled-content style=\"fixed-case\">OPR<\/jats:styled-content> for a small additional risk of neonatal complications. Our analysis pleads for a tailored management strategy, taking into account the personalised prognosis for (multiple) pregnancy and <jats:styled-content style=\"fixed-case\">PTB<\/jats:styled-content>.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1471-0528.12980","type":"journal-article","created":{"date-parts":[[2014,10,14]],"date-time":"2014-10-14T13:56:26Z","timestamp":1413294986000},"page":"825-833","update-policy":"http:\/\/dx.doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Should the individual preterm birth risk be incorporated into the embryo transfer policy in <i>in\u00a0vitro<\/i> fertilisation? 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