How concordant are the estimated rates of natural conception and in-vitro fertilization embryo transfer success?

Knowledge of the chance to conceive for the subfertile couple is important in the process of counselling and clinical decision making. There are no data available on the reproducibility of the clinician's ability to assess the chance to conceive, both after expectant management or treatment with in-vitro fertilization and embryo transfer (IVF-embryo transfer). We evaluated this reproducibility by means of a set of case histories presented to a panel of gynaecologists and endocrinologists, A poor reproducibility would indicate a strong need for the use of prognostic models. In 1995, 57 gynaecologists and 32 reproductive endocrinologists were asked to appraise the 1 year spontaneous conception chance as well as the cumulative success rate of three cycles for IVF-embryo transfer of four couples with different medical histories. The clinical and laboratory data of these couples were presented as case histories. The difference between the estimated spontaneous pregnancy chances and the success rate of IVF-embryo transfer was also calculated. Calculation of intra-class correlation coefficients, which can be considered as measures of the reproducibility, demonstrated a substantial reproducibility of the assessment of spontaneous conception chances, but a slight to fair reproducibility of the assessment of IVF-embryo transfer success rates. We conclude that the use of reliable prognostic models for IVF-embryo transfer in the management of subfertility is warranted.