Comment on ‘A multicentre randomized controlled trial of expectant management versus IVF in women with Fallopian tube patency’
Bibliographic record
Abstract
Sir, Thank you for the opportunity of responding to Dr Gnoth's comments on the EMVI Trial. As highlighted in our original manuscript, the comparison of first IVF cycle with three months of unprotected intercourse was pragmatic. Although a longer follow-up would have been desirable, it was not acceptable to patients. Faced with the potential of even 3 months of untreated observation rather than an immediate IVF treatment cycle, only one-third of eligible subjects agreed to enrol (Hughes et al., 2004). The study suggesting a conception rate of 54% following untreated observation was not particularly relevant to the EMVI sample (Snick et al., 1997). The mean age of EMVI subjects was 33 years and mean duration of subfertility 56 months (Hughes et al., 2004). Snick et al. (1997) followed younger women after only 12 months of unprotected intercourse, and not surprisingly, their spontaneous live-birth rate over the subsequent 24 months was ∼50%. However, the probability of live birth did not significantly increase over the subsequent 12 months. In this and other studies, following 36 months of unprotected intercourse, it fell to ≤1% per cycle (Collins et al., 1995). The cited cumulative pregnancy rate of only 54% following up to five cycles of IVF may also be a poor comparator because this does not reflect current practice (Stolwijk et al., 2000). Based on treatment between 1991 and 1998, this fails to reflect the substantial gains made in IVF success over the last decade, with delivery per cycle in 2001 reaching 33% (National Summary and Fertility Clinic Report, 2004). An important justification for the EMVI trial was the absence of valid data comparing current IVF outcomes with no treatment in couples with persistent subfertility and Fallopian tube patency. In this context, the study confirmed a marked difference in live-birth rate of only 1% per untreated cycle compared with 30% following a single IVF treatment cycle.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".