Maria Batsis

All Publications

• Early Functional Status Change After Cardiopulmonary Resuscitation in a Pediatric Heart Center: A Single-Center Retrospective Study. Pediatric cardiology Batsis, M., Dryer, R., Scheel, A. M., Basu, M., Figueroa, J., Clarke, S., Shaw, F. R., Wolf, M. J., Beshish, A. G. 2023; 44 (8): 1674-1683

  Abstract

  Children with cardiac disease are at significantly higher risk for in-hospital cardiac arrest (CA) compared with those admitted without cardiac disease. CA occurs in 2-6% of patients admitted to a pediatric intensive care unit (ICU) and 4-6% of children admitted to the pediatric cardiac-ICU. Treatment of in-hospital CA with cardiopulmonary resuscitation (CPR) results in return of spontaneous circulation in 43-64% of patients and survival rate that varies from 20 to 51%. We aimed to investigate the change in functional status of survivors who experienced an in-hospital CA using the functional status scale (FSS) in our heart center by conducting a retrospective study of all patients 0-18 years who experienced CA between June 2015 and December 2020 in a free-standing university-affiliated quaternary children's hospital. Of the 165 CA patients, 61% (n = 100) survived to hospital discharge. The non-survivors had longer length from admission to CA, higher serum lactate levels peri-CA, and received higher number of epinephrine doses. Using FSS, of the survivors, 26% developed new morbidity, and 9% developed unfavorable outcomes. There was an association of unfavorable outcomes with longer CICU-LOS and number of epinephrine doses given. Sixty-one-percent of CA patients survived to hospital discharge. Of the survivors, 26% developed new morbidity and 91% had favorable outcomes. Future multicenter studies are needed to help better identify modifiable risk factors for development of poor outcomes and help improve outcomes of this fragile patient population.

  View details for DOI 10.1007/s00246-023-03251-5

  View details for PubMedID 37587236

  View details for PubMedCentralID 4809365

• Velocity encoded mitral valve inflow cine: A novel and more reproducible method to determine cardiac rest periods during coronary magnetic resonance angiography. JRSM cardiovascular disease Markus, R., Tandon, A., Fares, M., Dillenbeck, J., Greil, G. F., Batsis, M., Greer, J., Potersnak, A., Zhang, S., Hussain, T., Avula, S. 2022; 11: 20480040221087556

  Abstract

  A high temporal resolution, 4-chamber (4CH) cine is the standard method for determining cardiac rest periods during whole heart coronary magnetic resonance angiography (CMRA). We evaluated the image quality and reproducibility between the 4CH cine method and a novel approach using a velocity encoded mitral valve inflow cine (MVI). The goal of this study was to compare the quality of CMRAs utilizing MVI versus 4CH methods. Sharpness and vessel length for the LCA and RCA using each method were determined using Soap Bubble and two blinded observers independently assessed coronary image quality. Offline analysis on a separate, retrospective cohort (n = 25) was used to compare MVI and 4CH reproducibility. In the prospectively evaluated cohort there was no difference in overall vessel sharpness (4CH vs MVI mean ± SD) (31.0 ± 5.5% vs 30.5 ± 5.7%, p = .63), LCA vessel sharpness (30.0 ± 5.4% vs 31.1 ± 8.2%, p = .44), LCA length (4.7 ± 1.4 cm vs 4.6 ± 1.6 cm, p = .66), RCA vessel sharpness (32.1 ± 6.9% vs 31.1 ± 7.7%, p = .55), RCA length (5.51 ± 2.6 cm vs 5.95 ± 2.4 cm, p = .38), or image quality rating (2.66 vs 2.62, p = .80) between methods. In the retrospective cohort, the MVI method had 5.4% lower inter-observer variability (95% CI 3.7,7.2%, p < .0001) and 3.9% lower intra-observer variability (95% CI 2.4,5.4%, p < .0001) than the 4CH method. MVI is a technically feasible and more reproducible method to determine cardiac rest periods compared to 4CH while preserving vessel sharpness, vessel length & image quality.

  View details for DOI 10.1177/20480040221087556

  View details for PubMedID 35342625

  View details for PubMedCentralID PMC8943306

• Association of Digoxin With Preserved Echocardiographic Indices in the Interstage Period: A Possible Mechanism to Explain Improved Survival? Journal of the American Heart Association Batsis, M., Kochilas, L., Chin, A. J., Kelleman, M., Ferguson, E., Oster, M. E. 2021; 10 (23): e021443

  Abstract

  Background For patients with hypoplastic left heart syndrome, digoxin has been associated with reduced interstage mortality after the Norwood operation, but the mechanism of this benefit remains unclear. Preservation of right ventricular (RV) echocardiographic indices has been associated with better outcomes in hypoplastic left heart syndrome. Therefore, we sought to determine whether digoxin use is associated with preservation of the RV indices in the interstage period. Methods and Results We conducted a retrospective cohort study of prospectively collected data using the public use data set from the Pediatric Heart Network Single Ventricle Reconstruction trial, conducted in 15 North American centers between 2005 and 2008. We included all patients who survived the interstage period and had echocardiographic data post-Norwood and pre-Glenn operations. We used multivariable linear regression to compare changes in RV parameters, adjusting for relevant covariates. Of 289 patients, 94 received digoxin at discharge post-Norwood. There were no significant differences in baseline clinical characteristics or post-Norwood echocardiographic RV indices (RV end-diastolic volume indexed, RV end-systolic volume indexed, ejection fraction) in the digoxin versus no-digoxin groups. At the end of the interstage period and after adjustment for relevant covariates, patients on digoxin had better preserved RV indices compared with those not on digoxin for the ΔRV end-diastolic volume (11 versus 15 mL, P=0.026) and the ΔRV end-systolic volume (6 versus 9 mL, P=0.009) with the indexed ΔRV end-systolic volume (11 versus 20 mL/BSA1.3, P=0.034). The change in the RV ejection fraction during the interstage period between the 2 groups did not meet statistical significance (-2 versus -5, P=0.056); however, the trend continued to be favorable for the digoxin group. Conclusions Digoxin use during the interstage period is associated with better preservation of the RV volume and tricuspid valve measurements leading to less adverse remodeling of the single ventricle. These findings suggest a possible mechanism of action explaining digoxin's survival benefit during the interstage period.

  View details for DOI 10.1161/JAHA.121.021443

  View details for PubMedID 34854311

  View details for PubMedCentralID PMC9075357

• Sinus Venosus Defects: Anatomic Variants and Transcatheter Closure Feasibility Using Virtual Reality Planning. JACC. Cardiovascular imaging Tandon, A., Burkhardt, B. E., Batsis, M., Zellers, T. M., Velasco Forte, M. N., Valverde, I., McMahan, R. P., Guleserian, K. J., Greil, G. F., Hussain, T. 2018

  View details for DOI 10.1016/j.jcmg.2018.10.013

  View details for PubMedID 30553676

• The association of protein intake (amount and type) with ovarian antral follicle counts among infertile women: results from the EARTH prospective study cohort. BJOG : an international journal of obstetrics and gynaecology Souter, I., Chiu, Y. H., Batsis, M., Afeiche, M. C., Williams, P. L., Hauser, R., Chavarro, J. E. 2017; 124 (10): 1547-1555

  Abstract

  To evaluate the association between protein intake (amount and type) and antral follicle count (AFC).Prospective cohort.Academic fertility centre.Two hundred and sixty-five women undergoing fertility treatments at an academic fertility centre and participating in an ongoing study on environment and reproductive health.We measured AFC in ultrasonographic evaluation among women undergoing infertility treatments. Women completed a previously validated semi-quantitative food frequency questionnaire. We used Poisson regression to evaluate the relation between protein intake and AFC while adjusting for age, body mass index, race, smoking status, and total energy intake.Antral follicle count.Among 265 women (mean age: 35.0 ± 3.9 years, 85% Caucasian), total protein intake (% energy) was unrelated to AFC. When protein from different food sources was considered separately, we found a negative association between dairy protein intake and AFC. The mean AFC was 14.4% (3.9-23.7%) lower for women in the highest quintile of dairy protein intake than for women in the bottom quintile after adjusting for potential confounders (P-trend = 0.04). This association was stronger among women who had never smoked (P-trend = 0.002) but was not observed among previous smokers (P-trend = 0.36). There were no associations between protein intake from either non-dairy animal or vegetable sources and AFC.Higher dairy protein intake (≥5.24% of energy) was associated with lower antral follicle counts among women presenting for infertility treatment. These findings should be further investigated in prospective studies also designed to clarify the biology underlying the observed associations.Higher dairy protein intake was associated with lower antral follicle counts in an infertile population.

  View details for DOI 10.1111/1471-0528.14630

  View details for PubMedID 28278351

  View details for PubMedCentralID PMC5568942

• Racial Disparities in Fertility Care: an Analysis of 4537 Intrauterine Insemination Cycles. Journal of racial and ethnic health disparities Dimitriadis, I., Batsis, M., Petrozza, J. C., Souter, I. 2017; 4 (2): 169-177

  Abstract

  Studies suggest that race may affect access to fertility treatments and their outcomes. We examined whether race affects the following: duration of infertility prior to seeking evaluation, diagnosis, treatment cycle characteristics, and outcomes.Design: Retrospective cohort.Academic fertility center.4537 intrauterine insemination ± ovulation induction (IUI ± OI) cycles/1495 patients.IUI following: (i) OI with either clomiphene citrate or gonadotropins and (ii) ultrasound-monitored natural cycles.Duration of infertility prior to seeking treatment, SART diagnosis, treatment cycle characteristics and outcomes (spontaneous abortion (SABR), clinical (CPR) and multiple pregnancy rates (MPR)).Asians and Hispanics compared to Caucasians waited significantly longer prior to seeking fertility evaluation (p < 0.01). The mean age of patients seeking infertility evaluation did not differ between groups nor did the type of treatment initially chosen by the patients. Idiopathic infertility was more common among Caucasians (p < 0.05, compared to all others) while PCOS and tubal factor infertility were more frequent among Hispanics (p < 0.05, compared to Caucasian, Asian, and mixed ancestry women) and decreased ovarian reserve was more common among African-Americans (p < 0.01, compared to Caucasians, Asians, and Hispanics). Gonadotropin cycle characteristics including dosing and duration of treatment, follicular recruitment, peak estradiol levels, and endometrial lining thickness differed between certain groups. However, no difference was found in CPR, MPR, and SABR between groups.Race affects timely access to infertility care, diagnosis, and treatment cycle characteristics but not outcomes. Considering the nation's growing multiracial population, understanding the effect of race on fertility care becomes increasingly important.

  View details for DOI 10.1007/s40615-016-0215-2

  View details for PubMedID 26983623

• Attention Deficit Hyperactivity Disorder in Pediatric Patients with Pheochromocytoma and Paraganglioma. Hormone and metabolic research = Hormon- und Stoffwechselforschung = Hormones et metabolisme Batsis, M., Dagalakis, U., Stratakis, C. A., Prodanov, T., Papadakis, G. Z., Adams, K., Lodish, M., Pacak, K. 2016; 48 (8): 509-13

  Abstract

  The aim of the study is to evaluate if there is an association between attention deficit hyperactivity disorder (ADHD) and the diagnosis of pheochromocytoma/paraganglioma (PHEO/PGL) in pediatric patients. A case series study of 43 patients under the age of 18 with PHEO/PGL tumors who were evaluated at the National Institute of Health between January 2006 and May 2014 is reported. Prior diagnosis of ADHD and treatment course with stimulant medications was recorded. Patient symptoms, catecholamine and metanephrine levels, tumor characteristics, and genetic analyses for syndromes associated with PHEO/PGL were evaluated. A chi-squared test was used to assess the prevalence of ADHD in the PHEO/PGL patients compared to the general population. Nine out of 43 (21%) of patients diagnosed with PHEO/PGL had been diagnosed with ADHD prior to tumor identification. Four of the 9 patients had been treated with amphetamine, dextroamphetamine, and/or methylphenidate, potentially exacerbating an adrenergic crisis. In addition, 4 patients exhibited hypertension at the initial diagnosis of their PHEO/PGL. Three patients had resolution of their ADHD symptoms after successful surgical removal of PHEO/PGL. Our study found a prevalence of ADHD in 21% of our PHEO/PGL patients, significantly higher than 7.2% seen in the general pediatric population. Symptoms of anxiety and difficulty in concentration in these patients may have been related to their underlying PHEO/PGL and were not recognized as part of the constellation of symptoms in a child with PHEO/PGL. In pediatric patients with hypertension and ADHD symptomatology, an evaluation to rule out PHEO/PGL is warranted prior to treatment with stimulant medications.

  View details for DOI 10.1055/s-0042-106725

  View details for PubMedID 27171833

  View details for PubMedCentralID PMC7441823

• Screening for GPR101 defects in pediatric pituitary corticotropinomas. Endocrine-related cancer Trivellin, G., Correa, R. R., Batsis, M., Faucz, F. R., Chittiboina, P., Bjelobaba, I., Larco, D. O., Quezado, M., Daly, A. F., Stojilkovic, S. S., Wu, T. J., Beckers, A., Lodish, M., Stratakis, C. A. 2016; 23 (5): 357-365

  Abstract

  Cushing disease (CD) in children is caused by adrenocorticotropic hormone (ACTH)-secreting pituitary adenomas. Germline or somatic mutations in genes such as MEN1, CDKIs, AIP, and USP8 have been identified in pediatric CD, but the genetic defects in a significant percentage of cases are still unknown. We investigated the orphan G protein-coupled receptor GPR101, a gene known to be involved in somatotropinomas, for its possible involvement in corticotropinomas. We performed GPR101 sequencing, expression analyses by RT-qPCR and immunostaining, and functional studies (cell proliferation, pituitary hormones secretion, and cAMP measurement) in a series of patients with sporadic CD secondary to ACTH-secreting adenomas in whom we had peripheral and tumor DNA (N=36). No increased GPR101 expression was observed in tumors compared to normal pituitary (NP) tissues, nor did we find a correlation between GPR101 and ACTH expression levels. Sequence analysis revealed a very rare germline heterozygous GPR101 variant (p.G31S) in one patient with CD. Overexpression of the p.G31S variant did not lead to increased growth and proliferation, although modest effects on cAMP signaling were seen. GPR101 is not overexpressed in ACTH-secreting tumors compared to NPs. A rare germline GPR101 variant was found in one patient with CD but in vitro studies did not support a consistent pathogenic effect. GPR101 is unlikely to be involved in the pathogenesis of CD.

  View details for DOI 10.1530/ERC-16-0091

  View details for PubMedID 26962002

  View details for PubMedCentralID PMC5017905

• The ARMC5 gene shows extensive genetic variance in primary macronodular adrenocortical hyperplasia. European journal of endocrinology Correa, R., Zilbermint, M., Berthon, A., Espiard, S., Batsis, M., Papadakis, G. Z., Xekouki, P., Lodish, M. B., Bertherat, J., Faucz, F. R., Stratakis, C. A. 2015; 173 (4): 435-40

  Abstract

  Primary macronodular adrenal hyperplasia (PMAH) is a rare type of Cushing's syndrome (CS) that results in increased cortisol production and bilateral enlargement of the adrenal glands. Recent work showed that the disease may be caused by germline and somatic mutations in the ARMC5 gene, a likely tumor suppressor gene (TSG). We investigated 20 different adrenal nodules from one patient with PMAH for ARMC5 somatic sequence changes.All of the nodules were obtained from a single patient who underwent bilateral adrenalectomy. DNA was extracted by standard protocol and the ARMC5 sequence was determined by the Sanger method.Sixteen of 20 adrenocortical nodules harbored, in addition to what appeared to be the germline mutation, a second somatic variant. The p.Trp476* sequence change was present in all 20 nodules, as well as in normal tissue from the adrenal capsule, identifying it as the germline defect; each of the 16 other variants were found in different nodules: six were frame shift, four were missense, three were nonsense, and one was a splice site variation. Allelic losses were confirmed in two of the nodules.This is the most genetic variance of the ARMC5 gene ever described in a single patient with PMAH: each of 16 adrenocortical nodules had a second new, 'private,' and--in most cases--completely inactivating ARMC5 defect, in addition to the germline mutation. The data support the notion that ARMC5 is a TSG that needs a second, somatic hit, to mediate tumorigenesis leading to polyclonal nodularity; however, the driver of this extensive genetic variance of the second ARMC5 allele in adrenocortical tissue in the context of a germline defect and PMAH remains a mystery.

  View details for DOI 10.1530/EJE-15-0205

  View details for PubMedID 26162405

  View details for PubMedCentralID PMC4572515

• Primary Aldosteronism and ARMC5 Variants. The Journal of clinical endocrinology and metabolism Zilbermint, M., Xekouki, P., Faucz, F. R., Berthon, A., Gkourogianni, A., Schernthaner-Reiter, M. H., Batsis, M., Sinaii, N., Quezado, M. M., Merino, M., Hodes, A., Abraham, S. B., Libé, R., Assié, G., Espiard, S., Drougat, L., Ragazzon, B., Davis, A., Gebreab, S. Y., Neff, R., Kebebew, E., Bertherat, J., Lodish, M. B., Stratakis, C. A. 2015; 100 (6): E900-9

  Abstract

  Primary aldosteronism is one of the leading causes of secondary hypertension, causing significant morbidity and mortality. A number of genetic defects have recently been identified in primary aldosteronism, whereas we identified mutations in ARMC5, a tumor-suppressor gene, in cortisol-producing primary macronodular adrenal hyperplasia.We investigated a cohort of 56 patients who were referred to the National Institutes of Health for evaluation of primary aldosteronism for ARMC5 defects.Patients underwent step-wise diagnosis, with measurement of serum aldosterone and plasma renin activity followed by imaging, saline suppression and/or oral salt loading tests, plus adrenal venous sampling. Cortisol secretion was also evaluated; unilateral or bilateral adrenalectomy was performed, if indicated. DNA, protein, and transfection studies in H295R cells were conducted by standard methods.We identified 12 germline ARMC5 genetic alterations in 20 unrelated and two related individuals in our cohort (39.3%). ARMC5 sequence changes in 6 patients (10.7%) were predicted to be damaging by in silico analysis. All affected patients carrying a variant predicted to be damaging were African Americans (P = .0023).Germline ARMC5 variants may be associated with primary aldosteronism. Additional cohorts of patients with primary aldosteronism and metabolic syndrome, particularly African Americans, should be screened for ARMC5 sequence variants because these may underlie part of the known increased predisposition of African Americans to low renin hypertension.

  View details for DOI 10.1210/jc.2014-4167

  View details for PubMedID 25822102

  View details for PubMedCentralID PMC4454793

• Preconceptional thyroid-stimulating hormone levels and outcomes of intrauterine insemination among euthyroid infertile women. Fertility and sterility Karmon, A. E., Batsis, M., Chavarro, J. E., Souter, I. 2015; 103 (1): 258-63.e1

  Abstract

  To evaluate differences in intrauterine insemination (IUI) outcomes among euthyroid women with preconceptional thyroid-stimulating hormone (TSH) values in the normal (0.4-2.4 mIU/L) and high-normal (2.5-4.9 mIU/L) ranges.Cohort study.A single fertility center.A total of 1,477 women who underwent 4,064 IUI cycles between the years 2004 and 2012.None.Live birth, clinical pregnancy, spontaneous abortion (SAB), and IUI cycle parameters.Cycles were categorized into 4 groups based on preconceptional TSH values: 0.40-1.36 mIU/L; 1.37-1.86 mIU/L; 1.87-2.49 mIU/L; and 2.50-4.99 mIU/L. No statistically significant differences were found in IUI cycle parameters, clinical pregnancy rates, or live births per initiated cycle among the 4 TSH groups. However, preconceptional TSH was inversely related to SAB and positively related to live birth among women who achieved a clinical pregnancy. In this group of women, cycles with TSH values between 2.5 and 4.9 mIU/L were related to lower odds of SAB (odds ratio: 0.32; 95% confidence interval: 0.16-0.65) and higher odds of live birth (odds ratio: 2.80; 95% confidence interval: 1.43-5.48) compared with cycles among women in the lowest TSH group.Among euthyroid patients, preconceptional TSH values in the high-normal range (between 2.5 and 4.9 mIU/L) are not associated with adverse IUI outcomes.

  View details for DOI 10.1016/j.fertnstert.2014.09.035

  View details for PubMedID 25439842

• Hair mercury concentrations and in vitro fertilization (IVF) outcomes among women from a fertility clinic. Reproductive toxicology (Elmsford, N.Y.) Wright, D. L., Afeiche, M. C., Ehrlich, S., Smith, K., Williams, P. L., Chavarro, J. E., Batsis, M., Toth, T. L., Hauser, R. 2015; 51: 125-132

  Abstract

  Total hair mercury (Hg) was measured among 205 women undergoing in vitro fertilization (IVF) treatment and the association with prospectively collected IVF outcomes (229 IVF cycles) was evaluated. Hair Hg levels (median=0.62ppm, range: 0.03-5.66ppm) correlated with fish intake (r=0.59), and exceeded the recommended EPA reference of 1ppm in 33% of women. Generalized linear mixed models with random intercepts accounting for within-woman correlations across treatment cycles were used to evaluate the association of hair Hg with IVF outcomes adjusted for age, body mass index, race, smoking status, infertility diagnosis, and protocol type. Hair Hg levels were not related to ovarian stimulation outcomes (peak estradiol levels, total and mature oocyte yields) or to fertilization rate, embryo quality, clinical pregnancy rate or live birth rate.

  View details for DOI 10.1016/j.reprotox.2015.01.003

  View details for PubMedID 25601638

  View details for PubMedCentralID PMC4425999

• Outcomes after intrauterine insemination are independent of provider type. American journal of obstetrics and gynecology Goldman, R. H., Batsis, M., Hacker, M. R., Souter, I., Petrozza, J. C. 2014; 211 (5): 492.e1-9

  Abstract

  We sought to determine whether the success of intrauterine insemination (IUI) varies based on the type of health care provider performing the procedure.This was a retrospective cohort study set at an infertility clinic at an academic institution. The patients who comprised this study were 1575 women who underwent 3475 IUI cycles from late 2003 through early 2012. Cycles were stratified into 3 groups according to the type of provider who performed the procedure: attending physician, fellow physician, or registered nurse (RN). The primary outcome was live birth. Additional outcomes of interest included positive pregnancy test and clinical pregnancy. Repeated measures log binomial regression was used to estimate the risk ratios (RR) and 95% confidence intervals (CI) for the outcomes and to evaluate the effect of potential confounders. All tests were 2-sided, and P values < .05 were considered statistically significant.Of the 3475 IUI cycles, 2030 (58.4%) were gonadotropin stimulated, 929 (26.7%) were clomiphene citrate stimulated, and 516 (14.9%) were natural. The incidences of clinical pregnancy and live birth among all cycles were 11.8% and 8.8%, respectively. After adjusting for female age, male partner age, and cycle type, the incidence of live birth was similar for RNs compared with attending physicians (RR, 0.80; 95% CI, 0.58-1.1) and fellow physicians compared with attending physicians (RR, 0.84; 95% CI, 0.58-1.2). Similar results were seen for positive pregnancy test and clinical pregnancy.There was no significant difference in live birth following IUI cycles in which the procedure was performed by a fellow physician or RN compared with an attending physician.

  View details for DOI 10.1016/j.ajog.2014.05.033

  View details for PubMedID 24881820

  View details for PubMedCentralID PMC4457274

• Patient-specific predictions of outcome after gonadotropin ovulation induction/intrauterine insemination. Fertility and sterility Goldman, R. H., Batsis, M., Petrozza, J. C., Souter, I. 2014; 101 (6): 1649-55.e1-2

  Abstract

  To use patient-specific and cycle-specific characteristics to predict clinical pregnancy, multiple pregnancy, and spontaneous abortion rates after gonadotropin ovulation induction (OI)/IUI.Retrospective chart review.Academic fertility center.A total of 1,438 women who underwent 3,375 gonadotropin OI/IUI cycles.Individual and cycle-specific characteristics were evaluated to determine predictors of the rates of clinical pregnancy, multiple pregnancy, and spontaneous abortion. Logistic regression using individual parameters was used to create predictive models.Clinical pregnancy (CPR), multiple pregnancy (MPR), and spontaneous abortion rates (SABR).Multiple predictors were identified for CPR, MPR, and SABR. The presence of at least two follicles ≥ 13 mm at ovulation trigger significantly increased CPR (odds ratio [OR], 95% confidence interval [CI] = 1.45, 1.18-1.78) and MPR (OR, 95% CI = 5.17, 2.16-12.41). An E2 level >400 pg/mL significantly increased MPR (OR, 95% CI = 9.54, 2.31-39.42). Logistic regression models were developed for individualized predictions of outcome.Regression analysis reveals the patient and cycle-specific characteristics that are significant predictors of CPR, MPR, and SABR after OI/IUI. Logistic models using significant or nearly significant predictors for CPR, MPR, and SABR offer improved predictive power relative to simpler models, and allow for the development of a risk calculator for personalized patient counseling.

  View details for DOI 10.1016/j.fertnstert.2014.02.028

  View details for PubMedID 24690238