Fertility prognosis: a moving target

Unexplained subfertility is, by definition, an unsatisfactory diagnosis; indeed, it could be argued that it is not a real ‘diagnosis’ at all. Instead, it is a situation in time commonly defined as the failure to achieve a clinical pregnancy after at least 12 months of regular unprotected sexual intercourse. This is evidenced by the high rate of natural conception in prolonged follow-up studies of couples with unexplained subfertility. Validated prediction models have been developed from these studies facilitating realistic counselling of couples with unexplained subfertility. These models, which have been applied in a number of countries, are used as decision tools in deciding whether to start fertility treatment or not.Models predicting conception are highly time-dependent. Consequently, prognostic estimates for conception by these “old-fashioned” models cannot be reused at a later time point. However, it is of clinical and practical relevance to predict the chance of pregnancy at different points in time after an original prognosis was set. Therefore, newer dynamic models have been developed that fine-tune prognosis over a period of time after the original prediction was made. The first models were able to update predictions of natural conception.In this issue of Human Reproduction, McLernon and colleagues present a new prediction model that can update a prognosis for conception, not only over a period of time but during a treatment period – either expectant management or active treatment. Such dynamic modelling allows more realistic counselling of couples with explained subfertility about different treatment options. Furthermore, these models can be implemented within scientific studies evaluating effectiveness of new and existing treatment strategies. The development of these prediction models was only possible because of long-term expectant management strategies for unexplained subfertility we used in the past. Notwithstanding their value there is one important point to consider: with widespread implementation of these models in guidelines, future replication and update of natural conception prediction in patients with unexplained subfertility might become almost impossible. (Nils Lambalk, Editor-in-Chief Human Reproduction)

“Chronic heart failure in 2016”: prognosis

Milano dal 25 al 27 febbraio 2016 Palazzo Clerici, in Via Clerici 5 “Chronic heart failure in 2016: prognosis”. Promosso dalla FONDAZIONE INTERNAZIONALE MENARINI.Il Simposio è organizzato dal Centro Cardiologico Monzino di Milano e dal Dipartimento di Scienze Cliniche dell’Università di Milano, ed è promosso dalla Fondazione Internazionale Menarini. Lo scompenso cardiaco è un fattore di rischio significativo per morte cardiovascolare. Ma come valutare questo rischio per ogni singolo paziente? Ci ha pensato il Centro Cardiologico Monzino di Milano, che ha realizzato il MECKI score (Metabolic Exercise, Cardiac, Kidney Index), uno strumento per la stima del rischio dello scompenso cardiaco, basato su dati ottenuti dal test cardiopolmonare e integrato con parametri ecocardiografici e di laboratorio.