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Long-term Impact of Fertility Treatment Study

生育治疗研究的长期影响

基本信息

批准号：
9707617
负责人：
MIGUEL HERNAN
金额：
$ 55.29万
依托单位：
MASSACHUSETTS GENERAL HOSPITAL
依托单位国家：
美国
项目类别：
财政年份：
2017
资助国家：
美国
起止时间：
2017-09-02 至 2022-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9707617
关键词：
Address Adolescence Adoption Adult Aftercare Animals Assisted Reproductive Technology Asthma Birth Characteristics Child Child Development Child Health Childbirth Clinic Clinical Clinical Treatment Country Couples Data Data Analyses Data Set Data Sources Denmark Development Diabetes Mellitus Diagnosis Disease Education Epigenetic Process Event Fertility Fertilization in Vitro Glucose Intolerance Health Health Services Accessibility Healthcare Hospitalization Human Hypertension Income Individual Infertility Insurance Coverage Intellectual functioning disability Intracytoplasmic Sperm Injections Investments Life Literature Malignant Childhood Neoplasm Malignant Neoplasms Massachusetts Maternal Age Measures Medical Metabolic Methodology Modernization Nature Netherlands Neurodevelopmental Impairment Outcome Parents Patients Population Pregnancy Probability Research Research Project Grants Resources Risk Sentinel Series Socioeconomic Status Source Statistical Methods Sweden Techniques Thyroid Diseases Time Variant Weight analytical method base cohort cost emerging adult evidence base follow-up functional outcomes infancy infertility treatment population based premature success trait treatment choice treatment effect treatment strategy

项目摘要

Use of fertility treatments is growing with as many as 10% of births occurring after use of assisted reproductive technologies (ART) or non-IVF fertility treatments (NIFT). These treatments often require substantial societal and individual investments of resources and time, yet there is little information on the long-term health or development outcomes for children born after treatment. Indeed, most of the existing literature centers around events occurring during birth or infancy, with limited and mixed findings about events later in life. This limited literature also reflects major methodological challenges, including (i) insufficient follow-up time to assess the development of medical conditions past adolescence and into adulthood; (ii) numerous potential confounders, including the original reason for needing treatment (infertility), and variation in access to and use of treatments, e.g., differential access by income or education; and (iii) use of analytic approaches that either do not address relevant sources of bias, or rely on ill-defined assumptions to assess treatment effects. To both address the need for more evidence and mitigate the methodological concerns, we propose to compare the risk of outcomes associated with different fertility treatments using multiple population-based, nationwide rich datasets combined with modern causal inference approaches. Our aims are to examine the impact of fertility treatments (stratified by the type of infertility) on two types of outcomes: 1) clinical events; and 2) educational events. We will study nearly 400,000 children born after fertility treatments during 1980-2020 in four populations (in Denmark, the Netherlands, Sweden, and Massachusetts). Across these populations, we have comprehensive, individual-level information on our outcomes and potential cofounders, e.g., types of infertility, treatments, education, income, and clinic traits. We will perform both predictive and causal analyses in order to inform clinicians and potential parents as they first consider use of fertility treatments, then choose between available treatments. Our statistical methods encompass a series of approaches starting with traditional survival and repeated measures analyses, and more recently developed techniques for causal analysis with observational data, e.g., inverse-probability weighting. We also will explore alternative approaches using instrumental variables and the g-formula. In short, this study provides the best opportunity to assess long-term outcomes in children born after fertility treatments, with the longest follow-up time, most extensive set of demographic, clinical, and treatment characteristics, and use of state-of-the-art analytic approaches.

生育治疗的使用正在增加，在使用辅助生殖后发生的分娩多达10%