TY - JOUR

T1 - Repeated implantation failure at the crossroad between statistics, clinics and over-diagnosis

AU - Somigliana, Edgardo

AU - Vigano, Paola

AU - Busnelli, Andrea

AU - Paffoni, Alessio

AU - Vegetti, Walter

AU - Vercellini, Paolo

PY - 2018

Y1 - 2018

N2 - The most common definition of repeated implantation failure (RIF) is the failure to obtain a clinical pregnancy after three completed IVF cycles. This definition, however, may lead to misuse of the diagnosis. To disentangle this, we set up a mathematical model based on the following main assumptions: rate of success of IVF constant and set at 30%; and RIF postulated to be a dichotomous condition (yes or no) with a prevalence of 10%. On this basis, the expected cumulative chance of pregnancy after three and six cycles was 59% and 79%, respectively. Consequently, the false-positive rate of a diagnosis of RIF is 75% and 51%, respectively. Increasing the rate of success of IVF or the prevalence of RIF lowers but does not make unremarkable the rate of false-positive diagnoses. Overall, this model shows that the commonly used definition of RIF based on three failed attempts in a standard population with good prognosis leads to over-diagnosis and, potentially, to over-treatments.

AB - The most common definition of repeated implantation failure (RIF) is the failure to obtain a clinical pregnancy after three completed IVF cycles. This definition, however, may lead to misuse of the diagnosis. To disentangle this, we set up a mathematical model based on the following main assumptions: rate of success of IVF constant and set at 30%; and RIF postulated to be a dichotomous condition (yes or no) with a prevalence of 10%. On this basis, the expected cumulative chance of pregnancy after three and six cycles was 59% and 79%, respectively. Consequently, the false-positive rate of a diagnosis of RIF is 75% and 51%, respectively. Increasing the rate of success of IVF or the prevalence of RIF lowers but does not make unremarkable the rate of false-positive diagnoses. Overall, this model shows that the commonly used definition of RIF based on three failed attempts in a standard population with good prognosis leads to over-diagnosis and, potentially, to over-treatments.

KW - False positive

KW - IVF

KW - Model

KW - Repeated implantation failure

UR - http://www.scopus.com/inward/record.url?scp=85032988318&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85032988318&partnerID=8YFLogxK

U2 - 10.1016/j.rbmo.2017.09.012

DO - 10.1016/j.rbmo.2017.09.012

M3 - Article

AN - SCOPUS:85032988318

VL - 36

SP - 32

EP - 38

JO - Reproductive BioMedicine Online

JF - Reproductive BioMedicine Online

SN - 1472-6483

IS - 1

ER -