Are Children Born After Assisted Reproductive Technology at Increased Risk for Adverse Health Outcomes?

Abstract

As assisted reproductive technologies (ARTs) are increasingly used to overcome infertility, there is concern about the health of the children conceived. The empirical evidence for associations with outcomes related to child health is variable and should be evaluated with consideration of methodological shortcomings. Currently, there is convincing evidence that ART treatment may increase the risk of a few outcomes. Experimental laboratory studies document that various constituents in culture media affect various embryo characteristics both positively and negatively. Multiple-gestation pregnancy and birth are increased with ART, both because of multiple embryo transfer and embryo splitting. There is evidence of an increase in chromosomal abnormalities among pregnancies conceived using intracytoplasmic sperm injection and low birth weight and preterm delivery among singletons conceived with all types of ART; however, there remains uncertainty about whether these risks stem from the treatment or the parental infertility. For some outcomes, data of an increased risk with ART are suggestive at best largely because of lack of purposeful study of sufficient size and scope. These include specific perinatal morbidities, birth defects, developmental disabilities, and retinoblastoma. The evidence for an association between ART and spontaneous abortion is inconsistent and weak. There is inconclusive evidence that ART may be associated with genetic imprinting disorders. For childhood cancer, chronic conditions, learning and behavioral disorders, and reproductive effects there is insufficient empirical research to date, but given the data for more proximal outcomes, these outcomes merit further study. Future research needs to address the unique methodological challenges underlying study in this area.

Meta-analysis of cancer incidence in children born after assisted reproductive technologies

“…The titles and the abstracts of the papers were screened independently by two experts, and 161 articles which contained information on both short-and long-term health outcomes of children born after ART were selected. Citation indices, bibliographies of the articles and review papers (Brinton et al, 2004;Schieve et al, 2004;Lightfoot et al, 2005) were also checked to complete the search. We selected a total of 14 studies that met the inclusion criteria for the meta-analysis.…”

“…Most papers on the consequences of ART concentrated on short-term outcomes, such as perinatal mortality, multiple pregnancies, weight at birth and malformations (reviewed in Schieve et al, 2004 andHansen et al, 2005), while few studies have considered the long-term effects of these techniques. Now that several children born after ART have reached adolescence, it is useful to study the possible long-term consequences of this procedure, such as cancer incidence.…”

Obstetric outcome and incidence of congenital anomalies in 2351 IVF/ICSI babies

“…Some of the complications have been attributed to a higher frequency of multiple births and to the increased risk of premature delivery; however, other reports indicate that also singleton IVF children have a greater risk of low birth weight and of congenital anomalies [8][9][10][11][12][13][14][15][16].…”

Assessing the Risk of Cerebral Palsy in Children Born after Assisted Conception – The Role of Multiple Pregnancy and Preterm Delivery / Procena rizika od cerebralne paralize kod dece začete vantelesnim oplođenjem – uloga višestruke trudnoće i prevremenog rođenja

“…The empirical evidences are variable and therefore should be considerably evaluated. Some studies suggested that there were potential difficulties for these children, such as genetic disorders, congenital malformations, preterm delivery, low birth weight and perinatal complications, developmental delays and disabilities, and behavioral and mental health difficulties (1,2,(9)(10)(11)(12)(13)(14)(15).…”

“…Most of the available findings suggest that there is a higher overall risk of CP in the population of children born after ART due to multiple births, preterm (<37 weeks of gestation) and very preterm (<32 weeks of gestation) delivery, low (<2500 g) or very low birth weight (<1500 g) (16)(17)(18)(19)(20). Also, these risk factors are strongly associated with numerous long-term health consequences, admission to neonatal intensive care units and prolonged hospitalization (11,(21)(22)(23).…”