Big data to improve reproduction and fertility outcomes

The National Perinatal Epidemiology & Statistics Unit (NPESU) is a joint unit of the Centre for Big Data Research in Health (CBDRH) and the UNSW School of Clinical Medicine.

The NPESU is considered a leading international research group in infertility and assisted reproductive technologies (ARTs). We apply our areas of methodological expertise in epidemiology, biostatistics and health economics to a variety of data sources including clinical trials, cohorts, large-scale population cohorts and linked administrative datasets.

Project: Cancer risk in women and children after medically assisted reproduction CREATE - NHMRC Project Grant

Infertility affects approximately one in six couples at a given time. Medically assisted reproduction (MAR), namely ovulation induction with hormonal medications and assisted reproductive technologies (ART) such as in vitro fertilisation, has helped millions of Australians achieve parenthood. 

Each year around 73,000 ART cycles and 70,000 cycles of ovulation induction are performed in Australia. MAR has been linked in some studies with an increased risk of cancer in women, particularly endometrial and ovarian cancer. At the same time, children born after MAR may also be at a higher risk of some cancer types including leukemia. 

Despite the strong biologic plausibility of carcinogenic risks from MAR, conclusive evidence regarding cancer risk in women and children after MAR is lacking due to the methodological limitations and small sample sizes of available studies. We propose the first Australian nationwide data-linkage project to address these questions via linkage of national prescription, medical services, perinatal, cancer, death and cancer screening data from 1991–2014.  

The incidence of cancer in women after MAR will be compared with women not exposed to MAR, while adjusting for major confounders. We will also explore whether the type of MAR treatment modifies the risk of cancer in these women. To explore the association of cancer risk with MAR in children aged 0–14 years, cancer incidence will be compared for three cohorts of children conceived:

a) After ART treatment.

b) After ovulation induction treatment. 

c) Spontaneously from fertile women.  

Individual level data from this project will then be pooled with those from the United Kingdom and the Nordic countries. This project will provide conclusive evidence regarding the association of cancer with MAR with an international, multidisciplinary team identifying the clinical and policy impacts.

Project: Male infertility research – Men and infertility over the lifecourse MAIL - MRFF EPCDRMRFF

One in 20 men suffer from infertility. We have assembled a world-class team of researchers and consumer advocates to apply advanced epidemiological and analytical techniques to answer key questions in male reproductive health. 

Four integrated research streams have been designed to provide a complete picture of the reproductive and general health of men suffering from infertility and their children over the lifecourse, thereby identifying potential causes and targets for prevention and treatment. 

Translation activities include a publicly available IVF patient predictor tool & fertility clinic success rate website allowing individuals to estimate their chances of IVF successful, clinical practice guidelines and a clinical trials portal. 

Project: ART Linkage

Assisted reproductive technologies (ART), such as IVF, represent one of the major developments of the past century allowing millions of couples to achieve parenthood. One in 25 children is conceived in Australia using ART. A further unknown proportion is conceived using prescribed medications in ovulation induction. The lack of conclusive findings on the role of these medically assisted fertility treatments on reproductive outcomes and the health outcomes of the children has created an increasing important evidence gap for advising patients, clinicians, and policy makers on their role in clinical practice and safety.

Population datasets in NSW and the ACT will be linked to the Australian and New Zealand.

Assisted Reproductive Technology Database (ANZARD) and the Pharmaceuticals Benefits Scheme (PBS) and the Medical Benefits Scheme (MBS). The aims of the study are to:

  1. Determine the number and proportion of children conceived by medically assisted fertility treatments, thus providing evidence on the role and contribution of ART and non ART treatments to clinical care, family formation and population demographics in Australia.
  2.  Estimate reproductive and obstetric outcomes of women and men following fertility treatments, including the proportion of children conceived spontaneously to women who have unsuccessfully undergone ART treatment or ovulation induction in Australia.
  3. Quantify the risk of adverse health outcomes in children under two years of age conceived from ART and non ART fertility treatments as compared to those spontaneously conceived after accounting for confounders, in particular underlying subfertility.
  4. Estimate the risk of adverse health outcomes in children conceived using the most commonly variations in ART practice: intracytoplasmic sperm injection, cryopreservation, extended embryo culture and multiple embryo transfer.
  5. Validate the ANZARD database against the MBS and NSW/ACT PDC.