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Frank J Broekmans

Publications and source records attributed to Frank J Broekmans.

8 recordsLinked to original sources
PubMed2006

Intrauterine insemination with controlled ovarian hyperstimulation versus expectant management for couples with unexplained subfertility and an intermediate prognosis: a randomised clinical trial.

BACKGROUND: Intrauterine insemination with controlled ovarian hyperstimulation is commonly used as first-line treatment for couples with unexplained subfertility. Since such treatment increases the risk of multiple pregnancy, a couple's chances of achieving an ongoing pregnancy without it should be considered to identify those most likely to benefit from treatment. We aimed to assess the incremental effectiveness of intrauterine insemination with controlled ovarian hyperstimulation compared with expectant management in couples with unexplained subfertility and an intermediate prognosis of a spontaneous ongoing pregnancy. METHODS: 253 couples with unexplained subfertility and a 30-40% probability of a spontaneous ongoing pregnancy within 12 months were randomly assigned either intrauterine insemination with controlled ovarian hyperstimulation for 6 months or expectant management for 6 months. The primary endpoint of this hospital-based study was ongoing pregnancy within 6 months. Analysis was by intention to treat. This trial is registered with the Dutch Trial Register and as an International Standard Randomised Clinical Trial, number ISRCTN72675518. FINDINGS: Of the 253 couples enrolled, 127 were assigned intrauterine insemination with controlled ovarian hyperstimulation and 126 expectant management. In the intervention group, 42 (33%) women conceived and 29 (23%) pregnancies were ongoing. In the expectant management group, 40 (32%) women conceived and 34 (27%) pregnancies were ongoing (relative risk 0.85, 95% CI 0.63-1.1). There was one twin pregnancy in each study group, and one woman in the intervention group conceived triplets. INTERPRETATION: A large beneficial effect of intrauterine insemination with controlled ovarian hyperstimulation in couples with unexplained subfertility and an intermediate prognosis can be excluded. Expectant management for 6 months is therefore justified in these couples.

Adult↗
PubMed2006

Value of ovarian reserve testing before IVF: a clinical decision analysis.

BACKGROUND: To assess the value of testing for ovarian reserve prior to a first cycle IVF incorporating patient and doctor valuation of mismatches between test results and treatment outcome. METHODS: A decision model was developed for couples who were considering participation in an IVF programme. Three strategies were evaluated: (I) withholding IVF without prior testing, (II) testing for ovarian reserve, and then deciding on IVF treatment if ovarian reserve was estimated to be sufficient, and (III) treatment with IVF without prior ovarian reserve testing. The outcome considered was the birth of a child. The valuation of the combination of the strategy conducted and the outcome accomplished was expressed on a distress scale in units of 'IVF cycles that were performed in vain'. Correct treatment with IVF and correct withholding of IVF were considered to bring no distress. The distress of withholding IVF in case pregnancy occurred is consequently specified by the ratio of the expected distress after incorrect withholding IVF to the expected distress after incorrect performing IVF (distress ratio). We interviewed both patients and doctors to determine realistic estimates for this distress ratio. RESULTS: The value of testing for ovarian reserve depends strongly on the expected pregnancy rate after IVF as well as on the valuation of the incorrect decisions from testing. For realistic ranges of the success rate after IVF and for distress ranges as were measured, treatment of all couples without testing was found to generate less distress than testing for ovarian reserve. The sensitivity and specificity of testing for ovarian reserve has to improve to 50 and 96% respectively, to make testing a valuable strategy. CONCLUSION: Based on the decision analysis, where current test accuracy and preference inventory among patients and physicians were used, testing for ovarian reserve seems not useful for current IVF programmes.

Attitude↗
PubMedDate not supplied

Antral follicle counts are related to age at natural fertility loss and age at menopause.

OBJECTIVE: The variability in ultrasound-based antral follicle counts sized 2-10 mm after allowing for age-related decline is considerable. This may represent differences in actual reproductive age among women. This hypothesis was tested by cohort comparison for distribution of age at occurrence of reproductive events. DESIGN: A model with a nonlinear mean decline with age was fitted to antral follicle counts (AFC) obtained in 163 regularly cycling fertile volunteers. Ages at last child birth and menopause were predicted from the individual AFC by using thresholds to represent these events and the model for decline with age. Distributions of the observed ages at last childbirth (proxy variable for loss of natural fertility) and ages at menopause were obtained from the BALSAC demographic database and the Prospect-EPIC study, respectively. The observed distributions were compared with the predicted distributions by using visual comparison and quantile-quantile plots. Predictions of age at last child and age at menopause were done using percentiles of the modeled AFC distribution for given age, and corresponding percentiles of the predicted distributions of age at these reproductive events, with predictions following from the position of a woman's AFC relative to these percentiles. RESULTS: The predicted distributions of age at last child and age at menopause showed good agreement with the observed distributions in the BALSAC and EPIC cohort. Compared with age alone, antral follicle counts gave some additional information for individual prediction of age at last child and menopause. CONCLUSIONS: The link between declining antral follicle counts and reproductively significant events like loss of natural fertility and menopause is strengthened by the high degree of similarity among the predicted and observed age distributions. Predictive usefulness of this relationship in a clinical setting may be more marginal, except in the case of women who have low AFCs for their age.

Adult↗