title: Is the wrong question being asked in infertility research?
abstract: A persistent finding is that assisted reproductive technology (ART) is associated with compromised birth outcomes, including higher risks for prematurity, low birthweight, and congenital malformations, even among singletons. Over the past decade, our research group, the Massachusetts Outcome Study of Assisted Reproductive Technology (MOSART), has evaluated pregnancy and birth outcomes among three groups of women, those women treated with ART, those with indicators of subfertility but without ART treatment, and fertile women. We have also explored the influence of infertility-related diagnoses on outcomes for women and infants. Over the course of our research, we have changed our perspective from an original focus on ART treatment parameters as the primary cause of excess morbidity to one centered instead on the underlying infertility-related diagnoses. This paper summarizes the research findings from our group that support this change in focus for infertility-based research from a primary emphasis on ART treatment to greater attention to the contribution of preexisting pathology underlying the infertility and suggests directions for future analyses.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, 965 Fee Road, East Fee Hall, Room 628, East Lansing, MI, 48824, USA. lukeb@msu.edu.
authors.forename: Barbara
authors.identifier: http://orcid.org/0000-0002-0405-8133
authors.initials: B
authors.lastname: Luke
authors.affiliation: Department of Obstetrics and Gynecology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
authors.forename: Judy E
authors.initials: JE
authors.lastname: Stern
authors.affiliation: Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Hornstein
authors.affiliation: MassGeneral Hospital for Children, Harvard Medical School, Boston, MA, USA.
authors.forename: Milton
authors.initials: M
authors.lastname: Kotelchuck
authors.affiliation: Massachusetts Department of Public Health, Boston, MA, USA.
authors.forename: Hafsatou
authors.initials: H
authors.lastname: Diop
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.affiliation: Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Eugene R
authors.initials: ER
authors.lastname: Declercq
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D007230:Infant, Low Birth Weight; D007234:Infant, Premature / Q000254:growth & development; D007246:Infertility / Q000235:genetics* / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D047928:Premature Birth; D027724:Reproductive Techniques, Assisted; D012106:Research
keywords: Adverse pregnancy outcomes; Assisted reproductive technology; Child health; Women’s health