SMART State Projects

Florida SMART Project Highlights

Between 1996 and 2006, the number of babies born in the U.S. using ART more than doubled. In 2006, Florida ranked 6th among the U.S. states in ART procedures started, but 20th in the number of ART procedures per one million population. Current projects underway include:

• Using linked data from vital statistics and the NASS file to examine the maternal characteristics of women who undergo ART procedures versus those who do not.
• Convening Florida SMART statewide workgroup that includes university, government, and private partners.
• Adding five new questions specific to infertility and ART to the statewide 2012 Florida Behavioral Risk Factor Surveillance Survey (BRFSS).

• The article “Obesity, Assisted Reproductive Technology, and Early Preterm Birth—Florida,
  2004–2006” by Sauber-Schatz, E. et al (paper will be published in American Journal of Epidemiology) shows if pre-pregnancy body mass index modifies the association between ART and preterm birth, and if this association varies by plurality.

Massachusetts SMART Project Highlights

• Massachusetts has been collecting information on the use of fertility medications and ART on birth certificate since 1997. In 2006, Massachusetts ranked 5th among the U.S. states in ART procedures started, but 1st in the number of ART procedures per one million population.
• In 2009, almost 1 out of every 20 births in Massachusetts was a multiple birth (4.7%); for women age 35+, 1 out of every 13 births was a multiple birth (7.5%). This high rate of multiple births is due in part to the extensive use of ART in the Commonwealth.
• The Massachusetts Pregnancy Risk Assessment Monitoring System (PRAMS) program has been collecting self-reported data on ART using the same questions as the birth certificate since 2007. In 2008, the Massachusetts Department of Public Health (MDPH) published a paper that compared ART use reported by PRAMS to ART use recorded on the birth certificate. Higher use of ART was reported by PRAMS than the birth certificate, particularly among women aged 25–34 years old and those having singleton births.
• Since 2011, Massachusetts has been collecting data on ART use both from the hospital and the mother on the birth certificate and will compare these results to linked NASS data to determine the best source of ART information for the birth certificate ascertainment.
• MDPH is also involved in another project linking fertility clinic data to birth related data.  MDPH is a partner with the Society for Assisted Reproductive Technology (SART), Boston University School of Public Health, and CDC on the MOSART study: Massachusetts Outcome Study of ART. This is an NIH-funded research effort to study maternal and infant outcomes and risks related to infertility.

Michigan SMART Project Highlights

• The Michigan SMART Surveillance project founded the Michigan Infertility Advisory Committee (MIAdCo) to be a part of the process, providing comment and quality assurance to the project. In 2006, Michigan ranked 14th among the U.S. states in ART procedures started, but 25th in the number of ART procedures per one million population.
• The committee is comprised of reproductive endocrinologists, infertility specialists, embryologist, genetic counselor, ethicist, scientists, neonatologists, and other stakeholders.
• The Michigan Infertility Surveillance Program utilizes data from multiple sources including the NASS/Michigan vital records linked files, Michigan hospital discharge files, birth defects and cancer registries, the Michigan Behavior Risk Factor Survey (MIBRFS) and the Pregnancy Risk Assessment Monitoring Surveillance. This provides a more comprehensive depiction of infertility, its treatment and outcomes among Michigan residents. Results of prior analyses:
  • The prevalence of infertility among Michigan adults 50 year or younger and who are married or are a member of an unmarried couple is estimated to be 10.2%
  • Of Michigan adults who reported using an infertility treatment 38.6% used infertility treatment only, 41.2% used a medical procedure and infertility medication and 20.2% used something else.
• While the Michigan SMART project will benefit all Michigan residents, certain groups have been identified as being underrepresented in current infertility surveillance and therefore will be targeted by the SMART project: Non-ART users, ART or non-ART users that were unable to conceive or to maintain a pregnancy, individuals or couples with infertility who have not sought medical treatment, people of lower socioeconomic status, and men.

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