Professor Arri Coomarasamy

Professor Arri Coomarasamy

Institute of Metabolism and Systems Research
Professor of Gynaecology

Contact details

Address
Institute of Metabolism and Systems Research
College of Medical and Dental Sciences
University of Birmingham
Edgbaston
Birmingham
B15 2TT
UK

Professor Arri Coomarasamy is the Director of Tommy’s National Centre for Miscarriage Research, with specialist teams in Birmingham, Coventry and London, putting patient priorities at the heart of efforts to tackle the widespread and devastating condition of early pregnancy loss.   

Professor Coomarasamy received his undergraduate medical education from the University of Birmingham, and completed his subspecialist training in reproductive medicine and surgery at Guy’s Hospital, London. 

Today Professor Coomarasamy leads a research group at the forefront of early pregnancy care, reproductive medicine and global women’s health. His portfolio includes numerous national and international multicentre randomised controlled trials, including the PROMISE trial (the role of progesterone in women with unexplained recurrent miscarriages), the TABLET Trial (levothyroxine therapy for women with thyroid antibodies), the PRISM Trial (progesterone therapy for women with early pregnancy bleeding), the RESPONSE Trial (G-CSF treatment for recurrent miscarriage), the AIMS trial (the effects of prophylactic antibiotics before miscarriage surgery in low-income countries) and the WHO CHAMPION trial (the role of carbetocin to prevent postpartum haemorrhage). He has published over 120 medical articles in high impact journals such as NEJM and the Lancet. 

Professor Coomarasamy takes particular pride in mentoring junior doctors and researchers, and several of his trainees have become outstanding clinicians and researchers. 

Professor Coomarasamy serves or has in the past served on several international and national committees, including the BJOG editorial board, the RCOG Wellbeing of Women Research Panel, various WHO committees, the Early Pregnancy Clinical Studies Group, the Reproductive Medicine Clinical Studies Group, and the GLOW organising committee. He is the founding trustee of Ammalife, a UK-registered charity with a global mission of reducing maternal deaths in low-income countries. 

Qualifications

MBChB, MD, FRCOG

Biography

Professor Coomarasamy received his undergraduate medical training from the University of Birmingham, and completed his subspecialist training in reproductive medicine and surgery at Guy’s Hospital, London. He gained his MD qualification in 2004 for work exploring the integration of diagnostic and therapeutic information, and since then has continued to move from strength to strength in the development of gynaecological research. 

Postgraduate supervision

Professor Coomarasamy tremendously enjoys supporting the next generation of academic and clinical investigators. He currently guides a cohort of six doctoral researchers in the fields of gynaecology and early pregnancy management, and his most recent PhD graduates have achieved outstanding success with publications in acclaimed academic journals such the BMJ and Lancet.

Research

Professor Coomarasamy pursues clinical and applied aspects of translational research including clinical trials, evidence synthesis and mixed methodology research. 

CLINICAL TRIALS 

•First trimester progesterone therapy in women with a history of unexplained recurrent miscarriages (PROMISE)

The recently completed PROMISE trial tested whether treatment with progesterone in the first trimester of pregnancy can reduce the risk of miscarriage in women with a previous history of unexplained recurrent loss. The study took place in approximately 40 hospitals across the UK and the Netherlands. 

•A randomised, double blind, multi-centre, placebo-controlled study to evaluate the efficacy, safety, and tolerability of NT100 in pregnant women with a history of unexplained recurrent pregnancy loss (RESPONSE)

The RESPONSE trial recently completed recruitment to test the efficacy, safety, and tolerability of NT100 in pregnant women with a history of unexplained recurrent pregnancy loss, at study sites throughout the UK. 

•Effectiveness of progesterone to prevent miscarriage in women with early pregnancy bleeding: a randomised placebo-controlled trial (PRISM)

PRISM tests whether progesterone hormone treatment for women with bleeding in early pregnancy can reduce their risk of miscarriage. The study is conducted at more than 30 study sites across the UK PROMISE network. 

•A multicentre placebo-controlled randomised trial of levothyroxine to reduce miscarriage risk in euthyroid women with thyroid auto-antibodies (TABLET)

TABLET seeks to evaluate the effects of thyroxine to prevent miscarriage in women with thyroid antibodies but normal thyroid function. The trial is operating in more than 30 centres across the UK, with several thousand screens to randomise 900 participants. 

•Effectiveness of antibiotic prophylaxis during surgical evacuation of the uterus for miscarriage management in low income countries (AIMS)

The AIMS (Antibiotics in Miscarriage Surgery) project proposes that antibiotics given just before miscarriage surgery could reduce the chances of infection, and tests the hypothesis through a large clinical trial in Malawi, Tanzania, Uganda and Pakistan. The study is endorsed by the WHO, FIGO and RCOG. 

•Carbetocin RTS for preventing postpartum haemorrhage: a randomised non-inferiority controlled trial

The Carbetocin RTS trial was commissioned by the WHO to test carbetocin RTS for preventing postpartum haemorrhage. The project brings together 12 participating centres from around the globe (Argentina, Brazil, Egypt, India, Kenya, Nigeria, Pakistan, Singapore, South Africa, Thailand and Uganda in addition to the UK). 

•Selection of sperm for assisted reproductive treatment by prior hyaluronic acid binding: increasing live birth outcomes and reducing miscarriage rates – multicentre randomised controlled, blinded trial (HABSelect)

Professor Coomarasamy is a co-applicant to the HABSelect project, testing a new method to select sperm for injection into the egg by their ability to stick to hyaluronan, a naturally occurring substance in the female tract. This is important because studies indicate that less than a quarter of all fertilised eggs implant to the womb and develop normally. 

•A multicentre trial of outpatient hysteroscopy before IVF, after recurrent IVF failures (TROPHY)

Professor Coomarasamy also supported the TROPHY trial of whether or not it may be useful to perform an outpatient hysteroscopy prior to the commencement of an IVF cycle, to improve the likelihood of achieving a live birth in women who have previously experienced between two and four IVF implantation failures. Located across three fertility centres in the UK, two sites in Belgium, two facilities in Italy and a clinic in the Czech Republic, the pan-European recruitment programme was recently completed with a total of 700 patients. 

EVIDENCE SYNTHESIS 

Professor Coomarasamy has accumulated significant expertise in the meta-analysis of effectiveness and test accuracy data, including advanced literature searching and data synthesis skills such as meta-regression, bivariate meta-analysis, pooling of receiver operating characteristics curves and funnel plot analysis. His work with Professor Zamora (Madrid, Spain) achieved the first and most comprehensive data analysis software (Metadisc) and it was made available free of charge to researchers worldwide. The software has been cited in the Lancet, JAMA, BMJ and other journal articles more than 880 times. Professor Coomarasamy is now collaborating to produce the next version of the product, with a facility for bivariate meta-analysis. 

Postpartum Haemorrhage (PPH) is the leading cause of maternal mortality in the developing world and contributes to nearly a quarter of all maternal deaths globally. Professor Coomarasamy is conducting a systematic review and network meta-analysis to evaluate the most effective uterotonic agents for preventing the condition. The study already promises to reap important findings for international policy development. 

MIXED METHODOLOGY RESEARCH 

•United Kingdom Early Pregnancy Surveillance Service (UKEPSS)

Professor Coomarasamy is the chief investigator of the UKEPSS programme which employs observational, cohort, case-control, qualitative and health economic studies to investigate serious conditions of early pregnancy and emergency gynaecology. The UKEPSS programme has established an extensive network of more than 80 Early Pregnancy Units across the UK.

Other activities

Professor Coomarasamy is a board member of numerous academic committees and working groups such as the RCOG Clinical Studies Groups in Early Pregnancy and Reproductive Medicine. He also maintains an international advisory role in the field of gynaecology, contributing to the recommendations of organisations such as the WHO.

Professor Coomarasamy is a founding trustee of Ammalife, an international charity with a mission to find solutions to maternal health problems through practical research and sustainable projects in the developing world. He is an enthusiastic communicator on the theme of research into global women’s health, and frequently delivers talks and seminars on this theme to a range of groups at local and national levels.

Professor Coomarasamy held scientific editorial responsibility for the BJOG for several years until 2010, and he continues to review numerous manuscripts for this and other leading publications in the field of reproductive health. He also maintains clinical responsibilities as a consultant gynaecologist with a special interest in early pregnancy management and reproductive medicine. 

Publications

Selected recent publications (total >150) 

 Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. El-Toukhy T; Campo R; Khalaf Y; Tabanelli C; Gianaroli L; Gordts SS; Gordts S; Mestdagh G; Mardesic T; Voboril J; Marchino GL; Benedetto C; Al-Shawaf T; Sabatini L; Seed PT; Gergolet M; Grimbizis G; Harb H; Coomarasamy; A. Lancet, April 27 2016.

A Randomized Trial of Progesterone in Women with Recurrent Miscarriages. Coomarasamy A; Williams H; Truchanowicz E; Seed P; Small R; Quenby S; Gupta P; Dawood F; Koot YE; Goddijn M; Bender Atik R; Bloemenkamp KWM; Brady R; Briley A; Cavallaro R; Cheong YC; Chu J; Eapen A; Ewies A; Hoek A; Kaaijk EM; Koks CA; Li TC; MacLean M; Mol BW; Moore J; Ross J; Sharpe L; Stewart J; Vaithilingam N; Farquharson R; Kilby M; Khalaf Y; Regan L; Rai R. New England Journal of Medicine, 2015 Nov 26, 373(22):2141-8. 

Association between response to ovarian stimulation and miscarriage following IVF: an analysis of 124 351 IVF pregnancies. Sunkara SK; Khalaf Y; Maheshwari A; Seed P; Coomarasamy A. Human Reproduction. 2014 Jun;29(6):1218-24. doi: 10.1093/humrep/deu053. 

Women's groups practising participatory learning and action to improve maternal and newborn health in low-resource settings: a systematic review and meta-analysis. Prost A; Colbourn T; Seward N; Azad K; Coomarasamy A; Copas A; Houweling TA; Fottrell E; Kuddus A; Lewycka S; MacArthur C; Manandhar D; Morrison J; Mwansambo C; Nair N; Nambiar B; Osrin D; Pagel C; Phiri T; Pulkki-Brännström A; Rosato M; Skordis-Worrall J; Saville N; More NS; Shrestha B; Tripathy P; Wilson A; Costello A. Lancet, Vol. 381, No. 9879, 18.05.2013, p. 1736-46. 

The effect of sperm DNA fragmentation on miscarriage rates: a systematic review and meta-analysis. Robinson L; Gallos ID; Conner SJ; Rajkhowa M; Miller D; Lewis S; Kirkman-Brown J; Coomarasamy A. Human Reproduction, Vol. 27, No. 10, 10.2012, p. 2908-17. 

Accuracy of single progesterone test to predict early pregnancy outcome in women with pain or bleeding: meta-analysis of cohort studies. Verhaegen J; Gallos ID; van Mello NM; Abdel-Aziz M; Takwoingi Y; Harb H; Deeks JJ; Mol BWJ; Coomarasamy A. BMJ, Vol. 345, e6077, 2012. 

Effects of interventions in pregnancy on maternal weight and obstetric outcomes: meta-analysis of randomised evidence. Thangaratinam S; Rogozinska E; Jolly C; Glinkowski S; Roseboom T; Tomlinson JW; Kunz R; Mol BW; Coomarasamy A; Khan KS. BMJ, Vol. 344, 2012, p. e2088. 

Diagnostic value of serum hCG on the outcome of pregnancy of unknown location: a systematic review and meta-analysis. van Mello N; Mol F; Opmeer B; Ankum W; Barnhart K; Coomarasamy A; Mol BW; van der Veen F; Hajenius P. Human Reproduction Update, Vol. 18, No. 6, 2012, p. 603-17.

Should androgen supplementation be used for poor ovarian response in IVF? Sunkara SK; Coomarasamy A; Arlt W; Bhattacharya S. Human Reproduction, Vol. 27, No. 3, 01.03.2012, p. 637-640. 

A comparison of clinical officers with medical doctors on outcomes of caesarean section in the developing world: meta-analysis of controlled studies. Wilson A; Lissauer D; Thangaratinam S; Khan K; MacArthur C; Coomarasamy A. BMJ, Vol. 342, d2600, 01.01.2011. 

Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. Sunkara SK; Rittenberg V; Raine-Fenning N; Bhattacharya S; Zamora J; Coomarasamy A. Human Reproduction, Vol. 26, No. 7, 01.07.2011, p. 1768-1774. 

Effectiveness of strategies incorporating training and support of traditional birth attendants on perinatal and maternal mortality: meta-analysis. Wilson A; Gallos I; Plana N; Lissauer D; Khan K; Zamora J; MacArthur C; Coomarasamy A. BMJ, Vol. 343, d7102, 01.01.2011. 

Does first trimester progesterone prophylaxis increase the live birth rate in women with unexplained recurrent miscarriages? Coomarasamy A; Truchanowicz E; Rai R. BMJ, Vol. 342, 01.01.2011, p. d1914.