The mission of the Assisted Reproductive Technology and health partnership (A.R.T-HEALTHPARTNERSHIP) is to provide reliable evidence on the effects of ART treatments on mothers’ and their children’s health.
What do we mean by conception by ART?
Assisted Reproductive Technology is defined as any treatment that includes the in vitro handling of both human oocytes (eggs) and sperm, or of embryos for the purpose of helping someone to become pregnant. Most ART is in vitro fertilisation (IVF) with or without intracytoplasmic sperm injection (ICSI). In vitro means something that takes place outside of the body, for example in a test.
Why is this research important?
Approximately 1 in 6 couples are infertile and ART is an established effective means of becoming pregnant. Over the last 30 years the use of ART globally has increased a lot, and continues to increase.
It has been suggested that becoming pregnant with ART might cause health problems during pregnancy and birth, and longer-term in both the mother and child, after the birth. It is important to determine whether this is true and if so, what health outcomes are affected by ART and how big the problem is.
Having good research on this means that where we show clearly there is no adverse effect of ART on mother and child health, couples can be reassured. Where we do see some adverse effects on health, we can start to think about, and research, how to prevent those adverse effects.
What are the challenges of this research? Why don’t we already know the answers?
It is difficult to get good unbiased reliable evidence on this because we cannot do randomised controlled trials, which are the best way of testing the effects of a treatment like ART.
Randomised controlled trials (RCT) involve randomising people (i.e. like tossing a coin) to have the treatment or not. Participants do not chose what they get.
Whilst RCTs have been good at showing how treatments like statins and blood pressure lowering tablets are safe and effective for reducing the risk of cardiovascular diseases, we cannot really randomise women to become pregnant by ART or natural conception. Those who do not have problems with infertility would not want to be randomised to ART and those who are infertile would be unlikely to want to be randomised to continuing to try to conceive naturally.
RCTs are theoretically possible for comparing different types of ART (for example IVF versus ICSI and fresh embryo transfer compared with frozen embryo transfer), but they are extremely expensive because of the large numbers of participants who would be needed to participate, particularly when looking at health outcomes in adulthood, many years after conception by ART. There is also evidence that it can be difficult to recruit participants to be randomised for different types of ART because they, or their doctors, have a strong preference for one treatment over another.
What are we doing to address these challenges?
In A.R.T- HEALTH we are comparing results from different types of study design, including birth cohorts, ART clinical cohorts and electronic health record linkage studies and different types of statistical analyses, where the different designs and statistical analyses have different strengths and limitations. This type of comparison has been called triangulation. The idea is that you compare results from as many different study types and analysis methods that have different strengths and limitations if the results are similar it is unlikely that is because of particular limitations in each study. Put another way if the limitations were having an important effect we would expect differences between studies with different limitations. So similar results across the studies increases or confidence that is the correct causal answer, whether it suggests ART has no effect, increases the risk of disease or decreases it.
Of course we might find differences between the different studies. That can also be helpful because before we start any analyses we will assess limitations and write down what effect we think these will have on the results. We can then use that, together with the actual results to decide what further research is needed.
We will keep this website updated with the study results that we find and access to the published research.