Judy E. Stern

Geisel School of Medicine at Dartmouth | DMS · Department of Obstetrics and Gynecology

Purpose: To elicit feedback from participants who completed the eMOMSTM study, a feasibility randomized controlled trial (NCT04021602), on their perceptions of program strengths and weaknesses. Study design: Qualitative - Semi-structured, telephone interview guide using open-ended questions. Setting: Rural Great Plains state, United States. P...

Objective: To identify independent risk factors for placenta accreta spectrum among pregnancies conceived with assisted reproductive technology. Design: Retrospective cohort study. Setting: Tertiary hospital. Patient(s): Individuals who conceived with assisted reproductive technology and reached 20 weeks’ gestation or later from 2011 to 2017. Inter...

Objective To identify independent risk factors for placenta accreta spectrum among pregnancies conceived with assisted reproductive technology. Design Retrospective cohort study. Setting Tertiary hospital. Patient(s) Individuals who conceived with assisted reproductive technology and reached 20 weeks’ gestation or later from 2011 to 2017. Inter...

Purpose: To evaluate whether underlying infertility and mode of conception are associated with childhood behavioral disorders. Methods: Oversampling on fertility treatment exposure using vital records, the Upstate KIDS Study followed 2057 children (of 1754 mothers) from birth to 11 years. Type of fertility treatment and time to pregnancy (TTP) w...

Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women, affecting approximately 6% to 15% of reproductive-aged women. Polycystic ovarian syndrome is associated with obesity, metabolic syndrome, impaired glucose tolerance, insulin resistance, adverse pregnancy outcomes, and infertility. Previous meta-analyses and reviews h...

Objective To define specific risk factors for placenta previa in pregnancies conceived with assisted reproductive technology (ART). Design Retrospective cohort. Setting Fertility centers and inpatient obstetric units in Massachusetts. Patient(s) Patients conceiving with ART and delivering at 20 weeks gestation or later between 2011 and 2017 in M...

Study question: Do women with polycystic ovary syndrome (PCOS) have a greater risk of adverse pregnancy complications (gestational diabetes, preeclampsia, cesarean section, placental abnormalities) and neonatal outcomes (preterm birth, small for gestational age, prolonged delivery hospitalization) compared to women without a PCOS diagnosis and doe...

Numerous studies have demonstrated that assisted reproductive technology (ART: defined here as including only in vitro fertilization and related technologies) is associated with increased adverse pregnancy, neonatal, and childhood developmental outcomes, even in singletons. The comparison group for many had often been a fertile population that conc...

Objective To evaluate whether children conceived using assisted reproductive technology (ART) or ovulation induction (OI) have greater cardiometabolic risk than children conceived without treatment. Design Clinical assessments in 2018–2019 in the Upstate KIDS cohort. Setting Clinical sites in New York. Patient(s) Three hundred thirty-three singl...

Objective: To compare the obstetric and perinatal outcomes of deliveries conceived with embryos from single-step vs. sequential culture media systems. Design: Historical cohort of Massachusetts vital records linked to assisted reproductive technology clinic data from the Society for Assisted Reproductive Technology Clinic Outcome Reporting Syste...

Objective To determine whether assisted reproductive technology (ART) treatment adds obstetric and neonatal risks over and above that of underlying infertility-related diagnoses. Design Retrospective study of linked ART, birth certificate, hospital discharge data, and outpatient insurance claims data in Massachusetts (2013–2017). Setting Database...

Despite centuries of lessons from history, war endures. Across Earth, during nearly every year from the beginning of the twentieth century to present day, over 30 wars have been fought resulting in 187 million casualties, excluding the most recent conflict, which is the impetus for this essay (Timeline of 20th and 21st century wars). We are, sadly,...

Purpose To investigate assisted reproductive technology (ART) outcomes among adolescent and young-adult female cancer survivors. Methods The Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to the Massachusetts Cancer Registry for 90,928 ART cycles in Massachusetts to women ≥ 18 years old fr...

Background Endometriosis and uterine fibroids are common gynecologic conditions associated with greater risk of infertility. Prior research has suggested that these conditions are associated with adverse pregnancy outcomes, potentially due to increased utilization of fertility treatments. Objective Therefore, our objective was to investigate wheth...

Objective To investigate hospitalizations up to 8 years after live birth among women who used assisted reproductive technology (ART) or who were subfertile compared with women who conceived naturally. Design Retrospective cohort. Setting Deliveries among privately insured women aged ≥18 years between 2004 and 2017 from Massachusetts state vital r...

Objective This study evaluates differences in child healthcare utilization by maternal fertility status in the first four years of life. Study design The retrospective cohort evaluated Massachusetts (MA) live born infants using data linked from clinical assisted reproductive technology (ART) data, birth certificates, and hospital discharge records...

Purpose We previously developed a subfertile comparison group with which to compare outcomes of assisted reproductive technology (ART) treatment. In this study, we evaluated whether insurance claims data in the Massachusetts All Payers Claims Database (APCD) defined a more appropriate comparison group. Methods We used Massachusetts vital records o...

Background: Contemporary embryo biopsy in the United States involves removal of several cells from a blastocyst that would become the placenta for preimplantation genetic testing (PGT). Embryos are then cryopreserved while patients await biopsy results, with transfers occurring in a subsequent cycle as a single frozen-thawed embryo transfer, if eu...

Objective: Assisted reproductive technology (ART)-treated women exhibit increased risk of premature delivery compared to fertile women. We evaluated whether ART treatment modalities increase prematurity and whether placental abnormalities and pregnancy-induced hypertensive (PIH) disorders mediate these risks. Method(s): This retrospective study...

Objective To investigate whether deoxyribonucleic acid (DNA) methylation at birth and in childhood differ by conception using assisted reproductive technologies (ART) or ovulation induction compared with those in children conceived without fertility treatment. Design Upstate KIDS is a matched exposure cohort which oversampled on newborns conceived...

Purpose Investigate the relationship between history of cancer and adverse pregnancy outcomes according to subfertility/fertility treatment. Methods Deliveries (2004–2013) from Massachusetts (MA) Registry of Vital Records and Statistics were linked to MA assisted reproductive technology data, hospital discharge records, and Cancer Registry. The re...

Purpose Among infants following ART-treated, subfertile, and fertile deliveries to determine (1) the presence and magnitude of sex differences in health outcomes and (2) whether the presence of sex differences varied among maternal fertility groups. Methods Retrospective cohort analysis of infants born in Massachusetts (MA) in 2004–2013 who were c...

Objective To evaluate the quantity and use of embryos cryopreserved at assisted reproductive technology (ART) clinics in the United States from 2004 through 2013 and to characterize trends in ART cycles in which all embryos were cryopreserved. Design Retrospective analysis. Setting Not applicable. Patient(s) Registry data from the Society for As...

Objective To determine the maternal demographic, health, and fertility variables underlying prematurity. Design Retrospective: Society for Assisted Reproductive Technology Clinic Outcome Reporting System data linked to Massachusetts birth certificates and hospital stays. Setting Not applicable. Patients We included 166,963 privately insured, sin...

Background Overweight and obesity are major risk factors for gestational diabetes among U.S. women. Evidence suggests that longer duration of breastfeeding among women with a history of gestational diabetes is associated with lower incidence of developing type 2 diabetes after pregnancy. Women may potentially benefit from a lifestyle change program...

Study question: Are toddlers conceived by fertility treatment at higher risk of failing a screening tool for autism spectrum disorders (ASD) than toddlers not conceived by treatment? Summary answer: Compared with children not conceived by infertility treatment, children conceived by any infertility treatment, ovulation induction with or without...

Objective: To compare incidence, risk factors, and etiology of women's deaths in fertile, subfertile, and undergoing assisted reproductive technology (ART) in the years after delivery. Design: Retrospective cohort. Setting: University hospital. Patient(s): Women who had delivered in Massachusetts. Intervention(s): This study used data from...

Introduction We examined the prevalence of autism spectrum disorders (ASDs) in Massachusetts (MA) comparing children born via assisted reproductive technology (ART) and children born to women with indicators of subfertility but no ART (Subfertile), to children born to women with neither ART nor indicators of subfertility (Fertile). We assessed the...

Purpose Pre-pregnancy and post-delivery hospitalizations were compared as markers for health among women who conceived using assisted reproductive technology (ART), non-ART medically assisted reproduction (MAR), no treatment (unassisted subfertile), and who were fertile. Methods We analyzed hospital discharge data linked to Massachusetts birth cer...

Background: Anti-Mullerian hormone is produced by small antral follicles and reflects ovarian reserve. Obesity is associated with lower serum anti-Mullerian hormone but it is unclear whether lower levels of anti-Mullerian hormone in women with obesity reflects lower ovarian reserve. Objective: To determine whether lower Anti-Mullerian hormone in...

Objective: To compare neonatal health outcomes after fresh versus frozen ET (FET). Design: Retrospective analysis of a population-based database of linked clinically assisted reproductive technology (ART) data with state vital records. Multivariable logistic regression was used to model the association between deliveries from fresh versus FET an...

Objective: The objective of this study is to measure delivery length of stay (LOS) and cost as proxies for infant morbidity in assisted reproductive technology (ART) and subfertile deliveries. Study design: Massachusetts singleton births, ≥ 23 weeks gestational age (GA) between 2004 and 2010, were linked with ART data, vital records, and hospita...

Purpose: To determine whether differences in birth outcomes among assisted reproductive technology (ART)-treated, subfertile, and fertile women exist in primiparous women with, singleton, vaginal deliveries. Methods: Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) data were linked to Massachusetts vital r...

Objective: To quantify the effect of medical and obstetrical factors on the odds of cesarean delivery, comparing assisted reproductive technology (ART)-treated women and women with subfertility not treated with ART versus fertile women. Design: Retrospective cohort. Setting: Not applicable. Patient(s): Singleton deliveries to primiparous wom...

Objectives: To assess the risk of adverse health outcomes for infants after assisted reproductive technology (ART)-treated and subfertile as compared with fertile deliveries. Methods: Live-born singleton infants ≥23 weeks' gestational age (GA) born in Massachusetts between July 1, 2004, and December 31, 2010, were analyzed by linking a clinical...

Objective: To analyze changes in intracytoplasmic sperm injection (ICSI) utilization, indications, and outcomes across U.S. regions. Methods: We conducted a retrospective cohort study. Data sets for 2000-2014 were obtained from the Centers for Disease Control and Prevention. Clinics with 100 or greater fresh, nondonor cycles were grouped by 10 n...

Purpose: The aim of this study is to evaluate frequency of hospitalization before, during, and after assisted reproductive technology (ART) treatment by cycle outcome. Methods: Six thousand and one hundred thirty women residing in Massachusetts undergoing 17,135 cycles of ART reported to the Society for Assisted Reproductive Technology Clinic Ou...

Background: Assisted reproductive technology (ART) has been associated with birth defects, but the contributions of multiple births and underlying subfertility remain unclear. We evaluated the effects of subfertility and mediation by multiple births on associations between ART and nonchromosomal birth defects. Methods: We identified a retrospect...

Background Anecdotal evidence suggests that US practice patterns for ART differ by geographical region. The purpose of this study was to determine whether use of ICSI differs by region and to evaluate whether these rates are correlated with differences in live birth rates. Methods Public data for 2012 were obtained from the Centers for Disease Con...

Background: Births to subfertile women, with and without infertility treatment, have been reported to have lower birthweights and shorter gestations, even when limited to singletons. It is unknown whether these decrements are due to parental characteristics or aspects of infertility treatment. Objective: To evaluate the effect of maternal fertil...

Background: It is unknown whether the risk of adverse outcomes in twin pregnancies among subfertile women, conceived with and without in vitro fertilization, differs from those conceived spontaneously. Objective: We sought to evaluate the effects of fertility status on adverse perinatal outcomes in twin pregnancies on a population basis. Study...

Background Children born from fresh in vitro fertilization (IVF) cycles are at greater risk of being born smaller and earlier, even when limited to singletons; those born from frozen cycles have an increased risk of large-for-gestational age (LGA) birthweight (z-score ≥1.28). This analysis sought to overcome limitations in other studies by using pa...

Study question: Does ICSI improve outcomes in ART cycles without male factor, specifically in couples with a history of tubal ligation as their infertility diagnosis? Summary answer: The use of ICSI showed no significant improvement in fertilization rate and resulted in lower pregnancy and live birth (LB) rates for women with the diagnosis of tu...

Purpose The objective of this study was to evaluate the effect of changing fertility status on perinatal outcomes of singleton siblings, conceived with and without assisted reproductive technology (ART). Method A longitudinal cohort study of Massachusetts resident women having two consecutive singleton births during 2004–2010 was performed. Women w...

Purpose: The purpose of the present study is to estimate the proportion of women with cancer who return to use the embryos that they have banked and to compare this proportion to that of women without cancer who bank embryos. Methods: This is a cohort study of three groups of women from New York, Texas, and Illinois who used embryo banking in th...

Objective: To assess the validity of outcome data reported to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System (SART CORS) compared with data from vital records and the birth defects registry in Massachusetts. Design: Longitudinal cohort. Setting: Not applicable. Participant(s): A total of 342,035 live births...

Objectives: We examined the prevalence of Early Intervention (EI) enrollment in Massachusetts comparing singleton children conceived via assisted reproductive technology (ART), children born to mothers with indicators of subfertility but no ART (Subfertile), and children born to mothers who had no indicators of subfertility and conceived naturally...

Objective: To assess whether risk of severe maternal morbidity at delivery differed for women who conceived using assisted reproductive technology (ART), those with indicators of subfertility but no ART ("subfertile"), and those who had neither ART nor subfertility ("fertile"). Methods: This retrospective cohort study was part of the larger Mass...

Background: It is unknown whether data obtained from maternal self-report for assisted reproductive technology treatment parameters and reproductive history are accurate for use in research studies. Objectives: We evaluated the accuracy of self-reported in assisted reproductive technology treatment and reproductive history from the Upstate KIDS...

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 e...

STUDY QUESTION How do the assisted reproductive technology (ART) outcomes of women presenting for ART after cancer diagnosis compare to women without cancer?

Objective To evaluate the risk of cancer after assisted reproductive technology (ART) therapy. Design Longitudinal cohort study. Setting Not applicable. Patient(s) New York, Texas, and Illinois residents between 2004 and 2009, treated with ART, comprising cycles of 113,226 women, including 53,859 women without prior ART treatment, who were linked t...