Epidemiologic Approaches for Studying Assisted Reproductive Technologies: Design, Methods, Analysis, and Interpretation

Messerlian, Carmen; Gaskins, Audrey J.

doi:10.1007/s40471-017-0105-0

Cited by 29 publications

(23 citation statements)

References 56 publications

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“…Finally, the authors restricted their analysis to cycles with an embryo transfer. We caution against this restriction, as it may lead to bias when the exposure of interest is associated with IVF failure points that occur prior to embryo transfer (Messerlian and Gaskins, 2017).…”

Section: Discussionmentioning

confidence: 99%

“…It is critical to ask appropriate questions and employ best practices in order to make inferences that could further our understanding of these processes. However, there is disagreement among investigators on whether to present odds or risks, and how to best incorporate data from multiple cycles (Messerlian and Gaskins, 2017). We have evaluated several methods to address these concerns and prefer the CWGEE model.…”

Section: Discussionmentioning

confidence: 99%

“…Developing and implementing valid, appropriate statistical approaches for evaluating predictors of success in studies of IVF remains a significant challenge in ART research (Messerlian and Gaskins, 2017). However, the field lacks consensus on which approaches are most appropriate for yielding unbiased parameter estimates, especially when considering multiple cycles (Buck Louis et al, 2005;Messerlian and Gaskins, 2017). Many couples receiving IVF treatment undergo multiple cycles before achieving a live birth or discontinuing treatment.…”

Section: Introductionmentioning

confidence: 99%

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Methodological approaches to analyzing IVF data with multiple cycles

et al. 2018

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Which methodological approaches are most appropriate for analyzing IVF data with multiple cycles in the context of a binary outcome? SUMMARY ANSWER: Both mixed effect models and generalized estimating equation (GEE) modeling approaches can account for multiple IVF cycles and may reduce bias over first-cycle only approaches, but CIs were narrowest with cluster-weighted generalized estimating equation models (CWGEE). WHAT IS KNOWN ALREADY: There is a lack of consensus among investigators regarding how to best incorporate data from multiple cycles and whether to present odds or risks in the analysis of IVF data. Failure to account for correlated outcomes within individuals and informative cluster size may lead to invalid CIs and biased estimates. STUDY DESIGN, SIZE, DURATION: The Environment and Reproductive Health (EARTH) Study is an ongoing prospective cohort study of subfertile couples conducted at an academic medical center. This cohort was established in 2004 and follows couples seeking treatment for infertility throughout the course of their treatment and pregnancy. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women aged 18-46 years enrolled in the EARTH Study from 2004 to 2017 who initiated at least one IVF cycle were eligible. Cycle initiation was defined as beginning ovulation induction with the intent to progress through an IVF or ICSI cycle. This analysis included 442 women undergoing 642 cycles who met the study inclusion criteria. We compared the results and interpretations of log-binomial and logistic models restricting to the first cycle, as well as mixed effects models, unweighted GEE models, and CWGEE models including all cycles. This analysis was conducted for two distinct exposures: maternal age at cycle initiation, and maternal preconception urinary concentrations of di(2-ethylhexyl) phthalate (DEHP) metabolites (previously reported to be associated with a decreased probability of live birth). MAIN RESULTS AND THE ROLE OF CHANCE: In general, the CIs were widest for mixed effects models and narrowest for CWGEE models. Further, in models evaluating the sum of urinary concentrations of DEHP metabolites (∑DEHP, available for 91% of women), the point estimates were surprisingly different between the first-cycle and multiple-cycle models. We observed significant associations between maternal age and live birth in all models. However, we observed no associations between ∑DEHP and live birth. LIMITATIONS, REASONS FOR CAUTION: This analysis was limited to an example dataset in which the true effect of any exposure is unknown. While this allows us to observe model performance in the context of real data, future analyses should be conducted within simulated datasets under various assumptions to further evaluate the appropriateness of each approach. In addition, we did not address differential loss to follow-up in our statistical approaches. WIDER IMPLICATIONS OF THE FINDINGS: The use of CWGEE models should be more widely considered in the analysis of IVF data with multiple cycles per woman. The CWGEE approach ...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Methodological approaches to analyzing IVF data with multiple cycles

et al. 2018

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“…Since 1978, the birth of the rst ART baby, more than 5 million children have been born via ART worldwide [9,10]. According to the latest ICMART (International Committee Monitoring Assisted Reproductive Technologies) world report, concerning ART treatments, Europe is the most affected, followed by Asia and North America [11].…”

Section: Introductionmentioning

confidence: 99%

Effect of medically assisted reproduction (MAR) and pregnancy planning on Bayley-III Screening Test subscales in preterm infants at 12 months of corrected age: a cross-sectional study

Szele¹,

Gáll²,

Nagy³

2020

Preprint

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Background The association between medically assisted reproduction and pregnancy planning on overall developmental outcomes of infants has been studied in relatively few studies. The availability of accurate tools for the early detection of developmental delays is a major issue. The purpose of this study is describing the average neurodevelopment of preterm infants and assessing the association between medically assisted reproduction, pregnancy planning and neurodevelopmental outcomes among Hungarian preterm infants. Methods Cross-sectional study of preterm infants with low birth weight (< 2500 g) and gestational age < 37 weeks (N = 171) who underwent developmental assessment using Bayley-III Screening Test (Bayley Scales of Infant and Toddler Development Screening Test – Third Edition) in three developmental domains (cognitive, language, motor) at 12 months of corrected age. We examined the developmental pattern of infants and the potential effects of medically assisted reproduction and pregnancy planning on Bayley-III Screening Test subscales. Information on the mode of conception and pregnancy planning was obtained through parental anamnesis. Results Concerning developmental delay, the language and motor subscales were the most affected. Examination of the mode of conception and developmental outcomes revealed higher neurodevelopmental skills in infants who were conceived through medically assisted reproduction. Significantly lower cognitive and language skills were found to be associated with unplanned pregnancies. Multi-way analysis of variance was conducted in order to assess the impact of the mode of conception and pregnancy planning on subscales. Conclusions We cannot unambiguously conclude that MAR and pregnancy planning had a solely positive effect on the development of preterm and low birth weight infants at 12 months of corrected age, but our results are vital for the design and implementation of further research.

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“…Most often, ECF is used in cases of obstruction or absence of uterine tubes; in cases of unclear reasons of infertility, decrease in total number of spermatozoids, disorders of their motility in men. However, despite initial successes, the efficiency of programmes of extracorporeal fertilization (ECF) has stagnated at the level of 20-35%, that is most attempts remain unsuccessful, and these failures are repeated among some patients (Simon & Laufer, 2012), which motivates further search for reasons for failure and the possibility of increasing the efficiency of ECF (Messerlian & Gaskins, 2017). Some researchers have identified a relationship between recurdescent failures of ECF and psychological factors (Coughlan et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Prothrombotic states in women with infertility and psychosomatic disorders

Kaminskyi¹,

Boychuk²,

Kolomiichchenko³

2019

Regul. Mech. Biosyst.

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Failures of in vitro fertilization (IVF) may be associated with prothrombotic states, the circulation of antiphospholipid antibodies (APA). 93 women with infertility were screened: the first group 32 women without severe psychosomatic disorders; the second group 61 women with psychosomatic disorders. The control group consisted of 30 fertile women. We carried out measurements in the blood serum of the level of AFA to membrane phospholipids (phosphatidylethanolamine, phosphatidylserine, cardiolipinum), antibodies to β2-glycoprotein (Iβ2-GPI), hemostasis (platelet count, ADP-induced platelet aggregation index, fibrinogen concentration, prothrombin index, activated partial thromboplastin time APTT, test for soluble fibrin-monomeric complexes, D-dimer), homocysteine, molecular genetic study of polymorphous variants for β-fibrinogen (C148T, 455GA) genes. The frequency of significant AFA titres in the group of women without psychosomatic disorders was 18.9%, and in women with psychosomatic disorders 44.3%, the rate of β2-GPI 9.6% in the first group versus 24.5% in the second group. Only in 11.5% of women in the second group elevated levels of APA were associated with β2-GPI and/or one or more clinical criteria for antiphospholipid syndrome (APS). In patients with infertility and psychosomatic disorders, we found increased platelet aggregation in the context of relative thrombocytopenia, higher fibrinogen levels, soluble fibrin-monomeric complexes, and prolonged APTT with elevated D-dimer levels. Some patients had hyperhomocysteinemia. In patients with psychosomatic disorders, the frequency of the minor alleles of the locus C148T and 455GA of the β-fibrinogen gene was greater than 40% (25–30% in first group). We distinguished factors that adversely affect the efficiency of IVF in the patients with psychosomatic disorders: elevation of APA; reduction in the number of thrombocites; growth of the ADP-induced aggregation index; extension of APTT; increase of fibrinogen, D-dimer; homocysteine; the presence of the minor allele of the T polymorphic locus C148T of the β-fibrinogen gene. The presence of prothrombotic states associated with APS should be taken into account when preparing for IVF and the appropriate correction should be made for them.

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Epidemiologic Approaches for Studying Assisted Reproductive Technologies: Design, Methods, Analysis, and Interpretation

Cited by 29 publications

References 56 publications

Methodological approaches to analyzing IVF data with multiple cycles

Methodological approaches to analyzing IVF data with multiple cycles

Effect of medically assisted reproduction (MAR) and pregnancy planning on Bayley-III Screening Test subscales in preterm infants at 12 months of corrected age: a cross-sectional study

Prothrombotic states in women with infertility and psychosomatic disorders

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