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ARRA Investments in Reproductive Health: Comparative Effectiveness Research

Public Health Burden
Uterine fibroids are the non-cancerous growths that occur in the wall of the uterus, causing painful menstrual periods, infertility, incontinence, and bowel obstruction. One study estimated that 1 of 4 American women —and up to 3 of 4 African-American women—have uterine fibroids. Infertility is another common reproductive health problem, with some studies estimating that 10 to 15 percent of American couples are affected. Several treatments are available to couples experiencing difficulties achieving pregnancy; however, many of these treatments also confer a ten- to twentyfold increase in the risk of multiple births. Infants born as one of a set of multiples are usually preterm, and often have a number of health problems due to their premature birth. Policy makers and public health professionals need to know what approaches work best to prevent illness and disease.

Comparative Effectiveness Studies
Across the United States, clinicians and patients confront important health care decisions without adequate information. Due to astonishing achievements in biomedical science, clinicians and patients often have a wide variety of choices when making decisions about diagnosis, treatment, and prevention, but it is frequently unclear which therapeutic choice works best for whom, when, and in what circumstances. Comparative effectiveness research (CER) helps provide information that helps clinicians and patients choose which option best fits an individual patient's needs and preferences.
  • Hysterectomy, or surgical removal of the uterus, is a common treatment for fibroids, but is not suitable for women who wish to retain the ability to have children. Two less-invasive surgical treatments are also available: one destroys a fibroid by cutting off its blood supply, and the other directs a high-energy ultrasound beam to heat and kill the fibroid. Although these treatments have shown promise in easing the pain women experience from fibroids, little research has been conducted to determine if one treatment is more effective than the other. Using ARRA funds, researchers will conduct a study of 220 women to compare the effectiveness of two techniques for relieving the pain associated with uterine fibroids.1
  • A two-year ARRA funded study will compare the effectiveness of three infertility drugs. Working with couples around the country, scientists will determine which of the three drugs is least likely to lead to multiple births while still overcoming infertility.2

  1. 5RC1HD063312-02 – Comparing focused ultrasound and uterine artery embolizaiton for uterine fibroids.
  2. 3U10HD038998-08S1, 3U10HD027049-18S1, 3U10HD055936-03S1, 3U10HD039005-08S1, 3U10HD055944-03S1, 3U10HD055942-03S1, 3U10HD038992-08S1, 3U10HD055925-02S1 – Comparison of the Multiple Gestation Rate after Ovarian Stimulation with either Clomiphene, Letrozole or Gonadotropins.

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