Long-term Follow-Up of Infertility Patients: A Pilot Study

描述（由申请人提供）：不孕症影响约12%的15-44岁女性; 35岁以上女性的患病率增加至约30%。2002年，在美国出生的所有婴儿中，约有1%是体外受精（IVF）的结果。用于卵巢刺激的促性腺激素药物是有效的，并导致雌激素水平比育龄妇女的典型水平高5-15倍。多个刺激周期变得越来越普遍，特别是自90年代中后期以来，因为诊所试图减少IVF期间移植的胚胎数量。虽然激素治疗（如口服避孕药和绝经后激素治疗）对健康的影响已经有了很好的记录，但令人惊讶的是，关于不孕症治疗的长期后果知之甚少。因此，我们建议进行一项试点研究，探讨在正在进行的护士健康研究II的参与者中开展与长期健康有关的不孕症治疗研究的可能性。护士健康研究II包括118，000名妇女，年龄在25-42岁，研究于1989年开始;自1995年以来，9，200名妇女报告了不孕症史，1，900名报告使用促性腺激素药物。护士健康研究II队列在研究不孕症治疗方面具有重要的优势，因为这些卫生专业人员可能会最大限度地减少因医疗保健知识和访问而造成的混淆。具体而言，我们建议：（1）为有不孕症史的参与者制定并验证补充问卷，以收集治疗史和利用率的数据以及其他相关信息;和（2）进行初步分析，包括探索与促性腺激素使用相关的高血压风险增加，以及良性乳腺疾病风险增加（这两者都是常见的结果，在适度的后续期后有足够的能力检测关系）。总的来说，这项拟议的试点研究有可能导致对与IVF和不孕症治疗相关的各种问题进行大量研究。例如，在护士健康研究II中，我们最终可以考虑进一步的结果，例如血管生物标志物，利用从受试者中收集的血液样本。此外，多年来，通过进一步的随访，我们可以检查临床心血管疾病，各种癌症等。公共卫生相关性：不孕症影响大约12%的15-44岁妇女。2002年，美国出生的婴儿中有1%是体外受精（IVF）的结果。用于卵巢刺激的促性腺激素药物是有效的，并导致雌激素水平比育龄妇女的典型水平高出5-15倍。尽管对健康有影响 激素治疗，如口服避孕药已被充分记录，关于不孕症治疗的长期后果知之甚少。因此，我们建议进行一项试点研究，探讨在正在进行的护士健康研究II的参与者中开展与长期健康有关的不孕症治疗研究的可能性。

DESCRIPTION (provided by applicant): Infertility affects approximately 12% of women aged 15-44 years; this prevalence increases to about 30% in women over age 35 years. In 2002, approximately 1% of all babies born in the US were a result of in- vitro fertilization (IVF). The gonadotropin drugs used in ovarian stimulation are potent, and lead to estrogen levels as much as 5-15 times higher than those typical for reproductive-age women. Multiple stimulation cycles have become increasingly common, especially since the mid to late nineties, as clinics have attempted to reduce the number of embryos transferred during IVF. Although health effects of hormonal treatments such as oral contraceptives and postmenopausal hormone therapy have been well- documented, surprisingly little is known regarding the long-term consequences of infertility treatments. Thus, we propose to conduct a pilot study exploring the possibility of initiating research on infertility treatment in relation to long-term health within participants of the ongoing Nurses' Health Study II. The Nurses' Health Study II includes 118,000 women, aged 25-42 years when the study started in 1989; since 1995, 9,200 women have reported a history of infertility, with 1,900 reporting use of gonadotropin drugs. The Nurses' Health Study II cohort has important advantages in studying infertility treatment, since confounding due to healthcare knowledge and access may be minimized in these health professionals. Specifically, we propose to: (1) develop and validate a supplementary questionnaire for participants with a history of infertility, to collect data on treatment history and utilization, and other relevant information; and (2) conduct preliminary analyses, including exploration of any increased risk of hypertension associated with gonadotropin use, and any increased risk of benign breast disease (both of these are common outcomes, with adequate power to detect relations after a modest follow-up period). Overall, this proposed pilot study has the potential to lead to substantial research on a wide variety of issues related to IVF and infertility treatment. For example, within the Nurses' Health Study II, we could eventually consider further outcomes, such as vascular biomarkers, taking advantage of blood samples which were collected from the subjects. In addition, over the years, with further follow-up, we could examine clinical cardiovascular disease, various cancers, etc. PUBLIC HEALTH RELEVANCE: Infertility affects approximately 12% of women aged 15-44 years. In 2002, one % of babies born in the US were a result of in-vitro fertilization (IVF). The gonadotropin drugs used in ovarian stimulation are potent, and lead to estrogen levels as much as 5-15 times higher than those typical for reproductive- age women. Although health effects of hormonal treatments such as oral contraceptives have been well-documented, little is known regarding the long-term consequences of infertility treatments. Thus, we propose to conduct a pilot study exploring the possibility of initiating research on infertility treatment in relation to long-term health within participants of the ongoing Nurses' Health Study II.