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  1. 1
    310566

    WHO grade "a" sperm motility and zona pellucida-binding test predict IVF outcome [letter] [reply]

    Sifer C; Poncelet C; Porcher R; Wolf JP

    Human Reproduction. 2007 Jan; 22(1):311-312.

    We thank Professor Evers for his interest in our preliminary work. We agree that a positive likelihood ratio (LR+) of 1.67 will change the likelihood of disease in a clinically not very relevant way. Indeed, we have moderated our purpose saying that an LR+ of 1.67 indicated a small impact on the post-test probability of successful IVF. However, this change was statistically significant as our study showed. Thus, we believe that in the lack of other predictive tests that could be performed routinely, this new combined test is helpful to decrease the risk of fertilization failure during IVF therapy in the case of unexplained infertility. Concerning male factor, we have found an LR+ of 6.0, which indicated a better, though moderate, post-test impact, as we have said in our study and accordingly to Professor Evers' letter. However, we effectively did not include the 95% confidence interval (CI) of this LR in our study, and we agree that this could lead to misinterpretation. We thought that this CI is calculated using an approximate formula, which could not be considered as valid on such a small sample. (excerpt)
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  2. 2
    310565

    WHO grade "a" sperm motility and zona pellucida-binding test predict IVF outcome [letter]

    Evers JL

    Human Reproduction. 2007 Jan; 22(1):311.

    I have read with great interest the article by Sifer et al. (2005) on the combination of a newly developed sperm-zona pellucida-binding assay and WHO grade 'a' sperm motility to predict sperm fertilizing ability in IVF. The authors have to be commended for developing a--theoretically very appealing--new sperm function test, and it is easy to understand how they could get carried away by their enthusiasm about the clinical applicability of this new test. In fact, the authors are so positive about the results of their combination test that they consider it 'an excellent predictor of sperm fertilizing potential in cases of mild male-factor infertility', and they recommend that it 'should be incorporated as a functional test to direct patients to IVF or ICSI at their first attempt'. They continue by stating that 'the positive LR of 1.67 (95% CI 1.07-2.59) allowed us to use this test in these cases' (i.e. in patients with unexplained infertility). (excerpt)
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