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Infertility Research Interview

Q. In layman's terms, what makes your study so significant? A. First, there hasn't been that much research in the field of infertility or assisted reproductive technologies looking at long-term outcomes. Most studies have focused on very early pregnancy losses or the newborn period with no long term follow-up. Our study is examining children up to 6 years of age who were born as a result of either infertility treatment or following a history of infertility, and comparing them to children born to women without infertility in the general population. We are currently interviewing women for this study and abstracting information from their medical records. We are recording detailed information regarding each woman's infertility history, her medical history, her pregnancies, and her labor and delivery. We also are recording information about any conditions the child may have or any special services they might have received. We are particularly interested in looking at neurodevelopmental outcomes in the children. Q. How is the study structured and what milestone have you reached? A. In a previous study, we had gathered minimal information on a group of 52,000 patients who sought infertility services in California many years ago. Since we wanted to examine recent pregnancies in these women, we linked this existing information to birth certificates and fetal death certificates to determine which of these women had experienced a stillbirth or live birth between 1994-1998. We also selected a matched set of women from the general population using the same birth certificate and fetal death certificate database. We then mailed these women letters inviting them to participate in the current study. We are now in the process of interviewing these women and abstracting their medical records. We are about 60% complete in gathering our data. We hope to analyze it next summer. Q. When do you expect to announce results? A. In April 2006 we expect to be done with data collection. By June of next year we hope to see results completed. We are now nearly done with data collection for the infertile women in this study and we're interviewing women from the general population comparison group. (Article continued-back page) Q. It is interesting that standard comparative data for common medical conditions are not already known. A. While we do know the incidence rates for many conditions in the general population, these numbers refer to everyone. In other words, the general population numbers include cases among children conceived using infertility treatments. In order to have comparative data, it is important to look at the groups separately. Q. What do you mean by “examining infertility etiology?” A. In trying to determine if there is an increased incidence of any adverse outcomes in these pregnancies or in the children, it is important to be able to tease out the effects of infertility per se from infertility treatments, other medical conditions, and advanced parental age. By looking at the reason(s) for infertility (the etiology) in combination with different treatment modalities and different conception methods, we can begin to tease out the independent effects of each. Q. Is there any accounting for multiples vs singletons? A. We are examining both singleton gestations and multiple gestations in this study. It is important to compare these two groups to each other, and to compare them across fertility groups (e.g., infertile vs. fertile). In a previous study I did with Dr. Rebecca Jackson here at UCSF, we performed a meta-analysis of singleton children conceived using IVF. These children had a significantly increased risk of low birth weight and prematurity as compared to singleton children in the general population. In our current study, we will be able to examine the same outcomes for multiple gestations. Q. Why did you choose to identify patients from 11 different clinics? A. By using many different institutions, we can examine different protocols and different types of patients. We are examining IVF with and without ICSI, IUI with and without ovarian hyperstimulation, as well as natural conceptions in infertile women and men. By including four Kaiser facilities, we also are able to look at a more diverse patient population. This is in contrast to the majority of other studies in Europe, Israel, and Australia that have focused solely on outcomes following IVF. Q. Nine months ago a journalist revealed in an article that you already identified increased autism and ADD in children conceived using assisted reproductive technologies. Is this accurate? A. No. The data was misinterpreted from a talk I gave at a professional meeting, and it was published without permission. We still have a lot of work left to do in this study and I don't know what the final results will indicate. Q. What led you to such a specialized field? A. I have been interested in reproductive and perinatal epidemiology since high school, and have worked in it ever since. But having gone through infertility treatment myself, I was frustrated by the lack of information available to help me make decisions. I knew that I could help other women by providing information to help them make the best decisions possible. Q. Can you comment on your ideas for future studies? A. We just submitted a grant application for our next study. In this study, we hope to have the children and their parents come to UCSF to be evaluated in person. The children in our study are now between 10-12 years of age, so it will be important to follow these children through adolescence and adulthood. Of particular interest is looking at the children's reproductive outcomes.

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