Infertility and public health

By Associate Professor Alex Wang, Director of Research Studies in the Faculty of Health at UTS

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Infertility remains a major public health problem in Australia, with 4.4% of all babies born using Assisted Reproductive Technology (ART) in 2013 (1).

What is infertility?

The World Health Organisation (WHO) defines infertility as the inability of a couple to achieve conception after one year of unprotected intercourse.

Infertility is shared equally among men and women, and one in six Australian couples suffer primary or secondary sub-fertility. It may be treated by medical or surgical techniques, or lifestyle changes.

The cost of ART

Although ART is an effective sub-fertility treatment, it comes at a great cost to couples.

The assessment and treatment of sub-fertility represents a significant economic activity in Australia with $244 million in Medicare Benefits Scheme benefits paid in 2013 alone (1).

Internationally, there is growing recognition of the impact of health complications and downstream costs associated with the maternal care of high risk and multiple gestation pregnancies, adverse events and the perinatal care of pre-term infants as a consequence of using ART.

One
ART treatment is in-vitro fertilisation, or IVF, which the research team
here at the UTS Faculty of Health has recently competed research on.

The risks of IVF

We found that these increased risks of adverse events vary between clinical procedures, patient groups, and potentially over time:

  • 5-fold increase in multiple births following ART cycles compared to all births.
  • 1.3-fold increase in gestational diabetes compared to non-ART mothers.
  • 1.2 fold increase in gestational hypertension and preeclampsia compared to non-ART mothers
  • 1.5-fold increase in fetal death for births following double embryo transfers (DET) compared to single embryo transfers (SET).
  • 1.6-fold increase of low birthweight for liveborn singletons following fresh embryo transfers than frozen transfers.
  • 1.3 fold increase of preterm birth for liveborn singletons following fresh embryo transfers compared to frozen transfers.
  • 1.5-fold increase in perinatal mortality compared to all births.
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IVF and ectopic pregnancies

Approximately one to two percent of pregnancies in Australia are ectopic, which means that the embryo attaches outside of the uterus.

But this rate is much higher in pregnancies that result from assisted reproductive technology such as IVF, with the rate being as high as 10%.

Here at the UTS Faculty of Health we have looked at the best IVF treatment to reduce the risk of ectopic pregnancy.

We
found a single frozen Day 5 embryo has the lowest risk of ectopic
pregnancies.

The reason is because in a fresh
treatment, the uterus environment is negatively impacted by the hormone
stimulation, whereas in a frozen embryo transplant, the uterus environment is
like a natural conception.

See more on our research here

IVF and gestational surrogacy

Another study (3) we conducted has found that single-embryo transfers should be advocated for all gestational surrogacy arrangements.

In our study of 360 gestational carrier cycles, we found little difference between the rates of clinical pregnancy and the rates of live delivery for single-embryo transfer (SET) or double-embyro transfer (DET).

However there were less babies born pre-term (13%) with SET than there were with DET (31%).

Furthermore, the chance of twin-birth was higher with DET (5 in 22) compared to SET (0 of 48).

See more on our research here


Other resources:

  1. Australian Institute of Health and Welfare. Australia’s mothers and babies 2013—in brief. Perinatal statistics series no. 31. Cat no. PER 72. 2015: Canberra, AIHW.
  2. The Fertility Society of Australia

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