Utah Fertility Experiences Study

Transcription

1 Cumulative live birth, time to live birth, and birth outcomes among a clinical sample of subfertile women in Utah, in relation to fertility treatments from medical records Joseph B. Stanford, MD, MSPH University of Utah Department of Family and Preventive Medicine Office of Cooperative Reproductive Health 2013 August 07

2 Utah Fertility Experiences Study Joseph B. Stanford, MD, MSPH University of Utah Department of Family and Preventive Medicine Office of Cooperative Reproductive Health 2013 August 07

3 Team Joseph Stanford, MD, MSPH Mark Gibson, MD Ahmad Hammoud, MD, MPH Shawn Gurtcheff, MD Ken Smith, PhD Marcia Feldkamp, PhD Jaewhan Kim, PhD Sara Ellis Simonsen, PhD Funded by NICHD, R21 Jessica Sanders, MSPH Scarlett Reeves, MSPH Alicia Fadrowsky Melissa Sperry Mandy Ward Alessandra Zimmerman Rita Sharshiner, MD Erik Linn, MD Melody Anderson, MD

4 Rationale Aims Linkage Clinic cohorts Population cohorts Initial results Discussion

5 Rationale Understanding the treatment choices of couples experiencing subfertility, and the outcomes those couples experience, is very important context for the practice of restorative reproductive medicine, and the discussion of options with patients.

6 Aims In clinic-based and population-based cohorts of women, determine the cumulative pregnancy rates and time to pregnancy for women who receive different fertility treatments, including no treatment. Determine the incidence of adverse neonatal outcomes of children born to women with infertility, including children conceived through ART, other fertility treatment, or no treatment.

7 Methods- linkage New patients or new IVF consults at REI clinics Dates of IVF and IUI procedures Link to Utah birth certificates

8 Linkage to birth certificates Conducted by Utah Population Database De-identified data file for analysis Assessment of ultimate outcomes for fertility treatments by birth certificate data Link couples with IVF or IUI to birth certificate outcomes Preterm birth Low birth weight Pregnancy complications

9 Data Linkage: UCRM N Birth % ART and IUI ART only IUI only Consult only Total

10 Hazard ratios for time to live birth Hazard Ratio (95% CI) Treatment ART and IUI 2.21 ( ) ART only 1.55 ( ) IUI only 1.27 ( ) ref Consult only Age category <25 years 4.01 ( ) years 3.47 ( ) years 3.21 ( ) years 2.26 ( ) 40 years ref Number of treatments received 0.94 ( )

11 Odds ratios for preterm birth Odds Ratio (95% CI) Treatment ART and IUI 2.29 ( ) ART only 1.87 ( ) IUI only 1.19 ( ) ref Consult only Age category <25 years 1.35 ( ) years 1.46 ( ) years 1.34 ( ) years 1.27 ( ) 40 years ref Number of treatments received 1.00 ( )

12 Odds ratios for low birth weight Odds Ratio (95% CI) Treatment ART and IUI 2.32 ( ) ART only 1.97 ( ) IUI only 1.16 ( ) ref Consult only Age category <25 years 0.72 ( ) years 0.95 ( ) years 0.92 ( ) years 0.81 ( ) 40 years ref Number of treatments received 0.99 ( )

13 Limitations No information on treatments other than ART and IUI Ovulation drugs Surgeries NPT or RRM Alternative treatments No information on going to other clinics We have not (yet) linked treatment dates to dates of birth for plausible direct cause-effect.

14 Strengths For women staying in Utah, we have hard data on outcomes, regardless of clinical follow-up. Ultimately, what outcomes do women experience who make certain treatment choices?

15 Discussion In this population seen at a REI specialty clinic, about half achieved a live birth over time, whether or not they received ART and/or IUI at the clinic. Women who chose ART had a shorter time to pregnancy (about twice as fast ) Women who chose ART also had about twice the probability of a preterm birth or low birth weight.

16 Discussion Future analyses Relationship of specific treatment cycles to births Cumulative probability of live birth: Does the gap narrow with time? Data from this study provide context and comparison for the inest and other studies.