Shift Needed in Focus of Infertility Research.

In the last decade, numerous studies have reported associations between assisted reproductive technology (ART) and adverse birth outcomes.

But a team of experts involved in those studies, including researchers from the School of Public Health, is urging a shift in focus from a primary emphasis on the effects of ART treatment to greater attention to the underlying infertility-related diagnoses that prompt ART interventions.

In a commentary in the Journal of Assisted Reproduction and Genetics titled, “Is the Wrong Question Being Asked in Infertility Research?” the research team says its studies have found that underlying subfertility and infertility have a greater impact on health outcomes for mothers and children than do in vitro fertilization and other ART procedures.

“In the course of multiple analyses, [we] have changed our perspective from an original focus on ART treatment as the primary cause of excess morbidity to one centered instead on the underlying infertility-related diagnoses,” wrote the research group, dubbed MOSART (Massachusetts Outcome Study of Assisted Reproductive Technology).

The group urged a shift in the research agenda “from the effects of a single intervention—the in vitro fertilization and assisted reproductive technologies—to the nature and consequences of infertility.”

Past MOSART studies have found that ART treatment is associated with increased risks of premature birth and other adverse outcomes, but only because of the higher likelihood of multiple births (twins etc.) and the transfer of multiple embryos. While women with infertility-related diagnoses were found to have higher risks for premature birth and low birth weight than fertile women, those risks were no different for those who had ART treatment and those who did not, the research group said.

Similarly, women with infertility diagnoses were found to have higher risks for pregnancy hypertension, gestational diabetes, and prenatal hospital admissions, but the presence or absence of ART treatment was not an independent factor in these risks.

“Over time,” the group wrote, “we have a developed a new hypothesis that, with the exception of higher rates of multiple pregnancies from ART and associated prematurity, underlying infertility-related diagnoses are the major effectors of excess morbidity for women and their children in this population.”

SPH co-authors on the article were Eugene Declercq, professor of community health sciences, and Howard Cabral, professor of biostatistics. Barbara Luke of Michigan State University was the lead author, with contributing authors from the Geisel School of Medicine at Dartmouth, Brigham and Women’s Hospital, Massachusetts General Hospital for Children, and the Massachusetts Department of Public Health.

—Lisa Chedekel