Georgina M Chambers

UNSW Sydney | UNSW · National Perinatal Epidemiology and Statistics Unit at the Centre for Big Data Research in Health and School of Women's and Children's Health

Background Globally, a stillbirth occurs every 17 seconds totalling almost 2 million every year. The global standard for reporting stillbirths is the stillbirth rate. While a critical and accessible summary statistic, it masks gestational age‐specific trends. Objectives This study aimed to summarise and critique stillbirth trends and document gest...

STUDY QUESTION Can we develop a prediction model for the chance of a live birth following the transfer of an embryo created using donated oocytes? SUMMARY ANSWER Three primary models that included patient, past treatment, and cycle characteristics were developed using Australian data to predict the chance of a live birth following the transfer of...

Background The Medicines Intelligence (MedIntel) Data Platform is an anonymised linked data resource designed to generate real‐world evidence on prescribed medicine use, effectiveness, safety, costs and cost‐effectiveness in Australia. Results The platform comprises Medicare‐eligible people who are ≥18 years and residing in New South Wales (NSW),...

title: International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2020 Study question In 2020 what was the global utilization, effectiveness and safety of ART? Summary answer Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effectiv...

The Medicines Intelligence (MedIntel) Data Platform is an anonymised linked data resource designed to generate real-world evidence on prescribed medicine use, safety, costs and cost-effectiveness in Australia. The platform comprises Medicare-eligible people who are ≥18 years and residing in New South Wales (NSW), Australia, any time during 2005-202...

Researchers interested in causal questions must deal with two sources of error: random error (random deviation from the true mean value of a distribution), and bias (systematic deviance from the true mean value due to extraneous factors). For some causal questions, randomization is not feasible, and observational studies are necessary. Bias poses a...

(Abstracted from Ann Intern Med 2023;176:1308–1320) In the United States, more than 2% of all infants are conceived by assisted reproductive technology (ART). Children born from ART have been shown to have up to 50% increased risk for congenital anomalies (CAs) compared with naturally conceived children.

BACKGROUND Family-planning policies have focused on contraceptive approaches to avoid unintended pregnancies, postpone, or terminate pregnancies and mitigate population growth. These policies have contributed to significantly slowing world population growth. Presently, half the countries worldwide exhibit a fertility rate below replacement level. N...

Background The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study demonstrated that scaling-up of direct-acting antiviral (DAA) treatment reduced hepatitis C virus (HCV) transmission. We evaluated the cost-effectiveness of scaling-up HCV treatment in state-wide prison services incorporating long-term outcomes across custodial a...

STUDY QUESTION What is the association between a country’s level of gender equality and access to ART, as measured through ART utilization? SUMMARY ANSWER ART utilization is associated with a country’s level of gender equality even after controlling for the level of development. WHAT IS KNOWN ALREADY Although gender equality is recognized as an i...

Background: More than 2 million children are conceived annually using assisted reproductive technologies (ARTs), with a similar number conceived using ovulation induction and intrauterine insemination (OI/IUI). Previous studies suggest that ART-conceived children are at increased risk for congenital anomalies (CAs). However, the role of underlying...

Study question: Does a public online IVF success prediction calculator based on real-world data help set patient expectations? Summary answer: The YourIVFSuccess Estimator aided consumer expectations of IVF success: one quarter (24%) of participants were unsure of their estimated IVF success before using the tool; one half changed their predicti...

Study question Does the transfer of a single vitrified-thawed blastocyst optimise obstetric and neonatal outcomes compared to a single fresh blastocyst transfer? Summary answer A single vitrified-thawed blastocyst transfer is associated with a lower risk of preterm delivery and small-for-gestational-age babies but a higher risk of large-for-gestat...

title International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2019 Study question In 2019 what was the global utilization, effectiveness and safety of ART? Summary answer Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effective...

Background: Hypertensive Disorders of Pregnancy (HDP) complicate 5-10% of pregnancies globally: 2-5% preeclampsia, 3% gestational hypertension, and 0.5-2% chronic hypertension. It is epidemiologically well established that adverse health effects of HDP do not end with the pregnancy: these conditions are associated with increased lifetime cardiovasc...

Background: With declining total fertility rates to below replacement levels amongst all high-, middle- and low-income countries, coupled with increasing use of medically assisted reproduction (MAR) treatments globally, we describe the impact of these treatments on completed family size and childbearing timing in a country with unlimited publicly...

Background: Using traditional health technology assessment (HTA) outcome metrics, such as quality-adjusted life-years, to assess fertility treatments raises considerable methodological challenges because the objective of fertility treatments is to create new life rather than extend, save, or improve health-related quality of life. Objective: The...

Background: Approximately 1 in 20 men are sub-fertile or infertile yet the aetiologies of male infertility remain largely unexplained. It is suggested that lifestyle choices and environmental factors contribute but research is limited. In particular, no study has evaluated early life exposures and subsequent male infertility. To address this knowl...

Unlabelled: Assisted reproductive technology (ART) is increasingly influencing the fertility trends of high-income countries characterized by a pattern of delayed childbearing. However, research on the impact of ART on completed fertility is limited and the extent to which delayed births are realized later in life through ART is not well understoo...

Assisted reproductive technologies are evolving, with the most recent example being the introduction of the freeze-all policy during which a fresh embryo transfer does not take place and all embryos of good quality are cryopreserved to be used in future frozen embryo transfers. As the freeze-all policy is becoming more prevalent, it is important to...

Background: A four-stream research program, Men and Infertility over the Lifecourse, is funded by the MRFF to address the medical, personal and social cost of idiopathic male infertility. This program includes a national case control study: AMIE. Designing and implementing AMIE poses both opportunities and challenges.

Background: Fertility clinics submit treatment data on all ART cycles to the Australian and New Zealand Assisted Reproductive Technology Database (ANZARD) as part of their accreditation. The National Perinatal Epidemiology and Statistics Unit (NPESU), who manages ANZARD, is undertaking a study involving the linkage of ANZARD to state and commonweal...

Abstract STUDY QUESTION Is geographic proximity to a fertility clinic associated with the likelihood of women of reproductive age undertaking different forms of medically assisted fertility treatment? SUMMARY ANSWER After adjusting for socioeconomic status (SES) and other confounders including a proxy for the need for infertility treatment, women...

Background Infertility is a medical condition affecting an estimated 186 million people worldwide. Medically assisted fertility treatments allow many of these individuals to have a baby. Insights about preferences of patients who have experienced fertility treatment should be used to inform funding policies and treatment configurations that best re...

Objective To assess the association between maternal asthma and adverse perinatal outcomes in an Australian Indigenous population. Methods This prospective cohort study included all Indigenous mother and baby dyads for births from 2001 to 2013 in Western Australia (n = 25 484). Data were linked from Western Australia Births, Deaths, Midwives, Hosp...

Spinal muscular atrophy (SMA) and severe combined immunodeficiency (SCID) are rare, inherited genetic disorders with severe mortality and morbidity. The benefits of early diagnosis and initiation of treatment are now increasingly recognized, with the most benefits in patients treated prior to symptom onset. The aim of the economic evaluation was to...

Evidence on the cost-effectiveness of newborn screening (NBS) for severe combined immunodeficiency (SCID) in the Australian policy context is lacking. In this study, a pilot population-based screening program in Australia was used to model the cost-effectiveness of NBS for SCID from the government perspective. Markov cohort simulations were nested...

The United Nations refers to South-South cooperation as a broad framework of collaboration between developing countries in the Global South. It can take place on a bilateral, regional, or interregional basis. Its main purpose is to share knowledge, skills, resources and successful initiatives to meet development goals through concerted partnerships...

title International Committee for Monitoring Assisted Reproductive Technologies (ICMART) Preliminary World Report on ART, 2018 Study question In 2018 what was global utilization, effectiveness and safety of ART? Summary answer Globally, ART utilization and data collection continue to increase but with wide variations in utilization, effectiveness...

Background From November 2019 to January 2020, eastern Australia experienced the worst bushfires in recorded history. Two months later, Sydney and surrounds were placed into lockdown for six weeks due to the COVID-19 pandemic, followed by ongoing restrictions. Many pregnant women at this time were exposed to both the bushfires and COVID-19 restrict...

Purpose The early postnatal period is a time of increased risk for psychiatric admission. However, there is scope to further examine if this increase in risk extends to the entire perinatal period (pregnancy and first postnatal year), and how it compares to admission outside of the perinatal period. Methods Data were linked across birth and hospit...

STUDY QUESTION In a country with supportive funding for medically assisted reproduction (MAR) technologies, what is the proportion of MAR births over-time? SUMMARY ANSWER In 2017, 6.7% of births were conceived by MAR (4.8% ART and 1.9% ovulation induction (OI)/IUI) with a 55% increase in ART births and a stable contribution from OI/IUI births over...

(Abstracted from Ultrasound Obstet Gynecol 2021;58:264–277) One of the risk factors for perinatal mortality and morbidity is abnormal fetal growth. The goal of this study was to study the prediction of adverse perinatal outcomes in preterm and term babies based on 3 birth weight (BW) standards (Australian population-based, Fenton, and INTERGROWTH-2...

BACKGROUND Despite the widespread use of assisted reproductive technology (ART), few studies analyse its impact on the total fertility rate (TFR). Furthermore, very little is known about how ART affects fertility at older reproductive ages and contributes to family size. OBJECTIVE We aim to quantify the contribution of ART to total and age-specific...

STUDY QUESTION What were the utilization, effectiveness and safety of practices in assisted reproductive technologies (ART) globally in 2014 and what global trends could be observed? SUMMARY ANSWER The estimated total number of ART cycles conducted in 76 participating countries in 2014 was 1.93 million representing ∼66% of global activity, with 5-...

Emerging evidence suggests trauma experienced in childhood has negative transgenerational implications on offspring mental and physical health. The objective was to investigate whether early life adversity experienced as bereavement is associated with chronic inflammatory health in offspring. The study population included three generations of Swedi...

IntroductionAssisted reproductive technologies (ART), such as in-vitro fertilisation (IVF), have revolutionised the treatment of infertility, with an estimated 8 million babies born worldwide. However, the long-term health outcomes for women and their offspring remain an area of concern. Linking IVF treatment data to long-term health data is the mo...

Background Abnormal fetal growth is a risk factor for perinatal mortality and morbidity. There is considerable debate about the choice and performance of growth charts to classify newborns as small or large for gestational age (SGA and LGA) as a proxy for the at-risk infants. Several international charts have been proposed to be adopted worldwide....

Objective To assess cost-effectiveness of newborn screening (NBS) for spinal muscular atrophy (SMA) and early treatment with nusinersen or onasemnogene abeparvovec (gene therapy), compared with nusinersen without SMA screening. Methods Informed by an Australian state-wide SMA NBS programme, a decision analytical model nested with Markov models was...

Objective: To evaluate three birthweight standards (Australian population-based, Fenton, and INTERGROWTH-21st ) and three estimated-fetal-weight [EFW] standards (Hadlock, INTERGROWTH-21st , and WHO) for classifying SGA, LGA, and predicting adverse perinatal outcomes in preterm and term babies METHODS: A nationwide population-based study was conduc...

Background & aims: Between 2014-2019, the SToP-C trial observed a halving in HCV incidence in four Australian prisons following scale-up of direct-acting antiviral (DAA) therapy. However, the contribution of HCV treatment to this decline is unclear due to the study not having a control group. We used modelling to consider this question. Approach...

Problem Although perinatal universal depression and psychosocial assessment is recommended in Australia, its clinical performance and cost-effectiveness remain uncertain. Aim To compare the performance and cost-effectiveness of two models of psychosocial assessment: Usual-Care and Perinatal Integrated Psychosocial Assessment (PIPA). Methods Women...

Objectives The aim of this study is to quantify societal preferences for, and assess trade-offs between characteristics of treatment programmes for impulsive-violent offenders. Setting The study was conducted in New South Wales, Australia’s largest state. Participants The study participants were income tax payers, aged over 18 and who were able t...

Background: Limited empirical evidence exists for the effectiveness of hepatitis C virus (HCV) treatment-as-prevention. The Surveillance and Treatment of Prisoners with hepatitis C (SToP-C) study aimed to assess the effect of HCV treatment-as-prevention in the prison setting. Methods: SToP-C was a prospective study, including a before-and-after...

Objectives To systematically review studies eliciting monetary value of a statistical life (VSL) estimates within, and across, different sectors and other contexts; compare the reported estimates; and critically review the elicitation methods used. Methods In June 2019, we searched the following databases to identify methodological and empirical s...

Background: With direct-acting antivirals dramatically reshaping the public health response to the hepatitis C virus (HCV), prisons are set to play a critical role in elimination efforts. Despite the theoretical demonstration of HCV treatment-as-prevention in prison in mathematical modeling, limited empirical data exist. The Australian 'Surveillan...

Objective To report the utilization, effectiveness, and safety of practices in assisted reproductive technology (ART) globally in 2013 and assess global trends over time. Design Retrospective, cross-sectional survey on the utilization, effectiveness, and safety of ART procedures performed globally during 2013. Setting Seventy-five countries and 2...

Objective: Variation in practice in relation to indications and timing for both induction of labour (IOL) and planned caesarean section (CS) clearly exists. However, the extent of this variation, and how this variation is explained by clinicians remains unclear. The aim of this study was to map the variation in IOL and planned CS at eight Australia...

In Australian prisons approximately 20% of inmates are chronically infected with hepatitis C virus (HCV), providing an important population for targeted treatment and prevention. A dynamic mathematical model of HCV transmission was used to assess the impact of increasing direct-acting antiviral (DAA) treatment uptake on HCV incidence and prevalence...

Background Australia has one of the highest rates of asthma worldwide. Indigenous children have a particularly high burden of risk determinants for asthma, yet little is known about the asthma risk profile in this population. Aim To identify and quantify potentially preventable risk factors for hospitalised asthma in Australian Aboriginal children...

Background Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around the timing of birth to reduce the risk of sti...

Research Question What is the optimal number of oocytes retrieved where the maximum live birth rate is observed after fresh autologous assisted reproductive technology (ART) cycles for women of different ages? Design This retrospective cohort study included all fresh autologous ART aspiration cycles (n=256,643) undertaken in Australia and New Zeal...

The health of children born through assisted reproductive technologies (ART) is particularly vulnerable to policy decisions and market forces that play out before they are even conceived. ART treatment is costly, and public and third-party funding varies significantly between and within countries, leading to considerable variation in consumer affor...

The association between the number of oocytes retrieved and fresh live birth rate (LBR) or cumulative LBR (CLBR) and whether there is an optimal number of oocytes retrieved where LBR or CLBR are maximised is one of the most relevant clinical questions, with conflicting results in available studies. A systematic review of all eligible studies (n=16)...

Study questions: In couples with unexplained infertility and a poor prognosis of natural conception, are four cycles of IUI with ovarian stimulation (IUI-OS) non-inferior to one completed cycle of IVF for the outcome of cumulative live birth? Are four cycles of IUI-OS associated with a lower cost per live birth compared to one completed cycle of I...

Study question: What was the utilization, effectiveness and safety of practices in ART globally in 2012 and what global trends could be observed? Summary answer: The total number of ART cycles increased by almost 20% since 2011 and the main trends were an increase in frozen embryo transfers (FET), oocyte donation, preimplantation genetic testing...

Objectives Women who had hypertensive disorders of pregnancy (HDP) are twice as likely to experience maternal cardiovascular disease later in life. The primary aim of this study (BP²) is to compare outcomes of 3 different management strategies (including lifestyle behaviour change (LBC) in the first 12 months postpartum in women who had HDP in thei...

Objectives To prepare more accurate population‐based Australian birthweight centile charts by using the most recent population data available and by excluding pre‐term deliveries by obstetric intervention of small for gestational age babies. Design Population‐based retrospective observational study. Setting Australian Institute of Health and Welf...

Objective To quantify the economic and health-related quality of life (HRQoL) burden incurred by households with a child affected by spinal muscular atrophy (SMA). Methods Hospital records, insurance claims, and detailed resource use questionnaires completed by caregivers were used to capture the direct and indirect costs to households of 40 child...

Study question: What are the success rates for women returning to ART treatment in the hope of having a second ART-conceived child. Summary answer: The cumulative live birth rate (LBR) for women returning to ART treatment was between 50.5% and 88.1% after six cycles depending on whether women commenced with a previously frozen embryo or a new ov...

Parity is a potential confounder of the association between medically assisted reproduction (MAR) and health outcomes. This concept paper describes a population-based record linkage study design for selecting MAR-unexposed women matched to the parity of MAR-exposed women, at the time of the first exposure to MAR. Women exposed to MAR were identifie...

Background Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around timing of birth to reduce the risk of stillbi...

Background: Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth may inform decision-making around timing of birth to reduce the risk of stillbirth from...

Background: Despite advances in the care of women and their babies in the past century, an estimated 1.7 million babies are born still each year throughout the world. A robust method to estimate a pregnant woman’s individualized risk of late-pregnancy stillbirth is needed to inform decision-making around timing of birth to reduce the risk of stillb...

This commentary outlines the importance of utilization of assisted reproductive technology as an indicator of access to infertility care and provides a standard way of reporting utilization to facilitate international comparisons. Factors that influence ART utilization as well as underlying inequalities and inequities in access to care are discusse...

Study question: How did general practitioners (GPs) (family physicians) manage infertility in females and males in primary care between 2000 and 2016? Summary answer: The number of GP infertility consultations for females increased 1.6 folds during the study period, with 42.9% of consultations resulting in a referral to a fertility clinic or spe...

This study estimates the future utilization of medically assisted fertility treatments in Australia, focusing on assisted reproductive technologies (ARTs), intrauterine insemination (IUI), and ovulation induction. A multistate cohort component population projection model is used to determine future fertility rates from 2016 to 2026 by age and educa...

Background: Indigenous Australian children are twice as likely to score poorly on developmental outcomes at age 5 years than their non-Indigenous peers. Indigenous children are also more likely to be born to younger mothers. We aimed to quantify the relationship between maternal age at childbirth and early childhood development outcomes in Indigen...

Background: Maternity populations are becoming increasingly multiethnic. Conflicting findings exist regarding the risk of adverse perinatal outcomes among immigrant mothers from different world regions and which growth charts are most appropriate for identifying the risk of adverse outcomes. Objective: To evaluate whether infant mortality and mo...

Study question: What is the number of oocytes where the maximum cumulative live birth rate per aspiration (CLBR) is observed during ART in women of different ages? Summary answer: The maximum CLBR was observed when around 25 oocytes were retrieved in women between 18-35 years of age, around 9 oocytes in women more than 45 years of age and contin...

For over forty years, assisted reproductive technology (ART) has helped millions of patients around the world to overcome infertility. Careful monitoring of ART treatments and their outcomes is vital to maintain the remarkable pace of change in science and technology, whilst minimizing potential risks to infertility patients, and their children. Wr...

Background Discrete-Choice Experiments (DCEs) are used to assess the strength of preferences and value of interventions, but researchers using the method have been criticised for failing to either undertake or publish the rigorous research for selecting the necessary attributes and levels. The aim of this study was to elicit attributes to inform a...

This paper helps to quantify the impact of the Australian National Perinatal Depression Initiative (NPDI) on postnatal inpatient psychiatric hospitalisation. Based on individual hospital admissions data from New South Wales and Western Australia, we found that the NPDI reduced inpatient psychiatric hospital admission by up to 50% [0.9% point reduct...