This is part of a series of articles showcasing the Sax Institute members’ diverse range of research with implications for future health policy and practice.
National Perinatal Epidemiology and Statistics Unit, UNSW Sydney
The innovative use of data analysis in the field of assisted reproductive technology (ART) is helping to give couples undergoing treatment new information about their chance of having a baby, researchers say.
Analyses of the Australian and New Zealand Assisted Reproduction Database (ANZARD)* can now estimate a woman’s chances of a live birth over the full course of an ART treatment program, involving multiple cycles, rather than on a per-cycle basis.
Associate Professor Georgina Chambers, Director of the National Perinatal Epidemiology and Statistics Unit (NPESU) at UNSW Sydney, said this provided a much more meaningful measure of success over a course of ART treatment and encouraged safer embryo transfer practices by reducing the focus on single-cycle pregnancy rates.
“Most women undergo multiple ART cycles, so it’s more meaningful to look at their chances of success from a program of treatment,” she said.
“It’s tempting to look at each cycle, but presenting the data over multiple cycles encourages couples, clinicians, and policy makers to consider IVF in a more holistic way.”
Associate Professor Chambers said policy makers could also use this data to better inform funding decisions.
“It allows policy makers to see how IVF success rates change by age and by number of cycles – and that again, provides a more realistic reflection of clinical practice.”
In a prospective study published in the Medical Journal of Australia, Associate Professor Chambers and colleagues followed up more than 56,000 women who had commenced ART between 2009 and 2014 to produce data on the differences in live birth rates between the first and eighth cycles of treatment, to help inform women about treatment choices.
The analyses considered an ART cycle as including the transfer of both fresh and frozen/thawed embryos resulting from one ovarian stimulation cycle and provided estimates of treatment success from repeated treatment attempts by the one women.
The researchers calculated two measures: a woman’s chance of achieving her first live birth in a particular cycle; as well as a woman’s overall chance of a live birth in a particular cycle, taking into account the number ART cycles previously undertaken (the cumulative live birth rate).
The researchers also analysed the impact of age on ART success rates, showing the markedly higher success rates for women starting IVF at age 30-34 years, compared with 40-44 years. However, Associate Professor Chambers emphasised that these are population estimates and every couple is different. “These new data provide a range of results that can be expected,” she said.
While the present dataset does not take into account several important individual characteristics – such as body mass index and period of infertility – Associate Professor Chambers said the NPESU hoped to incorporate more prognostic factors in future analyses to provide women with more individualised estimates.
She said a longer-term goal was to develop a “prediction calculator” where a woman’s own characteristics could be used to estimate of her chances of delivering a baby with treatments undertaken in Australia and New Zealand.
Associate Professor Chambers said the ART study was part of a larger program of NHMRC-funded research in reproductive medicine being undertaken by the Unit, with other projects looking at the health outcomes in babies conceived using ART, and the policy demographic implications of ART.
Associate Professor Chambers is a member of the ART Working Group of the Medicare Benefits Schedule (MBS) Review. The group has submitted recommendations on 21 MBS items, which will be considered in the final review.
*The Australian and New Zealand Assisted Reproduction Database (ANZARD) is funded by the Fertility Society of Australia (FSA), and is a collaborative initiative of the National Perinatal Epidemiology and Statistics Unit (NPESU) and fertility clinics in Australia and New Zealand. The NPESU is a unit within the Centre for Big Data Research in Health and the School of Women’s and Children’s Health of the University of New South Wales, Sydney.
The Sax Institute’s unique organisational structure, with 48 members from public health and health services research groups and their universities, connects us with a powerful public health network and world‑leading research expertise.