Embryo morphologic quality in relation to the metabolic and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection: a matched cohort study

Zhang, Chunxi; Xue, Jinglei; Zhao, Wei; Wu, Yiqing; Liu, Xin-Yi; Wang, Siwen; Li, Ling-Hui; Gu, Simeng; Li, Jia-Qun; Zhang, Yanye; Zhang, Fanghong; Yang, Ying-Zhi; Wang, Yue-Mei; Zhu, Yimin; Xing, Lihong; Qian, Yuping; Zhang, Dan

doi:10.1016/j.ajog.2022.05.019

Cited by 8 publications

(3 citation statements)

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“…However, a study by Zhang et al [ 56 ] revealed that singleton children born following a poor-quality embryo transfer had comparable full-scale, verbal, and performance intelligence as measured with the Weschler Preschool and Primary Scale of Intelligence in comparison to children born following a good-quality transfer. Thus, other factors might have a more significant role in intelligence and motoric ability development.…”

Section: Discussionmentioning

confidence: 99%

Intelligence, motoric and psychological outcomes in children from different ART treatments: a systematic review and meta-analysis

Djuwantono,

Aviani,

Permadi

et al. 2023

J Neurodevelop Disord

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Background Subtle abnormalities in children’s intelligence, motor skills, and psychology from various assisted reproductive treatments (ARTs) might be underdiagnosed. Understanding the prognosis of intelligence, motor skills, and psychology in children from ART would provide parents with reasonable expectations and enable them to plan relevant support to achieve the optimum potential in ART children. Methods We searched PubMed, EMBASE, Ovid, Google Scholar, and Scopus databases until April 13, 2021, to identify relevant studies. Thirty-four studies met the inclusion and exclusion criteria. The meta-analysis employed a standardized mean difference model. The outcome of this study is to compare intelligence quotient (IQ), motoric ability, and behavioral problems between all ARTs, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) to naturally conceived (NC) children. Subdomains of intelligence based on the Cattell, Horn, and Carroll Model (CHC Model) of cognitive architecture, including fluid reasoning, short-term and working memory, processing speed, visual-spatial ability, long-term memory retrieval, and crystalized intelligence (knowledge), were evaluated and summarized in details. Motor skill was stratified into two domains: gross motoric and fine motoric. Behavioral problem was categorized as externalizing and internalizing behavior. Results Meta-analysis showed that verbal intelligence score in IVF toddlers is significantly lower than NC toddlers (p = 0.02); conversely, ICSI toddlers scored significantly higher verbal intelligence score compared to NC toddlers (p = 0.005). Toddlers born after ART had significantly lower non-verbal intelligence score (p = 0.047). IVF toddlers scored significantly lower fine motor score (p = 0.01) compared to naturally conceived toddlers. Based on parent's CBCL, NC toddlers had higher total (p = 0.01) and externalizing behavior (p = 0.001) scores compared to ART toddlers. Evaluation of full scale IQ and all domains of intelligence in preschool and primary school children revealed that no significant differences exist between ART and NC children. Based on preschool and primary school parents' CBCL, IVF children had significantly lower externalizing behavior score compared to NC children (p = 0.04). Meta-analyses of studies on young adolescents revealed that ART young adolescents scored higher academically than their NC counterparts, including on mathematics (p < 0.00001) and reading or language (p < 0.00001). Conclusions Despite differences in certain aspects, this finding suggests that ART is unlikely to cause negative impacts on children’s neurodevelopment.

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Section: Discussionmentioning

confidence: 99%

Intelligence, motoric and psychological outcomes in children from different ART treatments: a systematic review and meta-analysis

Djuwantono,

Aviani,

Permadi

et al. 2023

J Neurodevelop Disord

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“…Minimal sufficient confounder sets to be adjusted were determined by DAGitty and included parental age (at delivery, years), parental education level (<college, ≥college), parental occupation type (categorized into three categories based on the European Socioeconomic Classification [E-SeC] and former study ( Berger et al. , 2019 ; Zhang et al. , 2022 ): more advantaged [E-SeC classes 1–3], middle [E-SeC classes 4–6], and less advantaged [E-SeC classes 7–9]), parental BMI (calculated by dividing weight in kilograms by height in metres squared), parental asthma (self-report of a physician’s diagnosis), smoking exposure (self-reported smoking by the mother, father, or other main caregivers of the child), residence type (rural or urban living based on the participants’ registered home addresses and Chinese administrative divisions), and infertility for estimating the total effect of ART on asthma risk in offspring.…”

Section: Methodsmentioning

confidence: 99%

The risk of asthma in singletons conceived by ART: a retrospective cohort study

Liu,

Zhou,

Wang

et al. 2024

Human Reproduction Open

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STUDY QUESTION Do singleton children conceived by ART have a higher asthma risk than naturally conceived (NC) singletons? SUMMARY ANSWER The asthma risk was similar for ART-conceived singletons and NC singletons, and there were no clear differences between the various types of ART. WHAT IS KNOWN ALREADY Whether ART increases asthma risk in offspring is questionable. The evidence is inconsistent and limited by ethnicity, geographic distribution, inadequate confounder adjustment, unsatisfactory control groups and specific methods of ART. Furthermore, the mediating effects of obstetric and neonatal outcomes on the association between ART and asthma remain unclear. STUDY DESIGN, SIZE, DURATION This observational, single-centre study was conducted at a reproductive centre of an affiliated university hospital, between September 2009 and April 2023. A total of 3227 singletons aged 3-6 years conceived by IVF versus ICSI or fresh versus frozen embryo transfer were retrospectively enrolled, and a total of 1206 NC singletons of the same age were subsequently recruited. PARTICIPANTS/MATERIALS, SETTING, METHODS Asthma was self-reported physician diagnosis or wheezing in the past 12 months. We performed multivariable logistic regression analyses for associations between asthma in offspring and ART use, with adjusting for parental characteristics (age, education level, occupation type, BMI, asthma), smoking exposure, residence type, child sex, child age and year of follow-up. Mediating effects were explored using longitudinal mediation structural equation modelling. MAIN RESULTS AND THE ROLE OF CHANCE Asthma was reported for 51 (4.2%) of the 1206 NC singletons (median [interquartile range, IQR] age 5 [4-5] years; 48.1% females) and 169 (5.2%) of the 3227 ART- conceived singletons (5 [5-5] years; 47.6% females). We found that risks of childhood asthma in singletons conceived by ART were, overall, similar to those of NC singletons, before (odds ratio [OR], 1.25 [95% CI, 0.92-1.74]; P = 0.170) and after adjustment (adjusted OR [aOR], 0.66 [95% CI, 0.44-1.03]; P = 0.126). Results were similar in multiple sensitivity analyses and there were no clear differences in asthma risks according to method of ART. Mediation analysis revealed a significant positive indirect effect of neonatal intensive care unit (NICU) admission (standard path coefficient, b = 0.025, P < 0.05) and a negative indirect effect of breastfeeding (b = -0.012, P < 0.05) on the association between ART and asthma in singleton offspring. LIMITATIONS, REASONS FOR CAUTION This study is limited to singletons only and cannot be generalized. The study is also limited by its retrospective observational single centre nature and sample size. Mediation analyses were exploratory. Therefore, the findings need to be interpreted with caution. WIDER IMPLICATIONS OF THE FINDINGS These findings can help infertile couples undergoing ART be reassured about the risk of childhood asthma in singleton offspring. Breastfeeding is recommended as a potentially feasible intervention to reduce the asthma risks in ART-conceived children who are at increased potential risk of asthma, such as those with NICU admissions. STUDY FUNDING/COMPETING INTEREST(S) This work was supported by the Key Research and Development Program of Zhejiang Province (2021C03100), the National Key Research and Development Program of China (2021YFC2700603), and the Program for Key Subjects of Zhejiang Province in Medicine and Hygiene to Zhu, the Zhejiang Province Natural Science Foundation (No. LQ22H040006) and the National Natural Science Foundation of China (No.82101759) to Tang, and the National Natural Science Foundation of China (No. 82201860) to You. The authors declare no competing interests. TRIAL REGISTRATION NUMBER ChiCTR2300069906

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“…Another embryonic factor for successful implantation is the quality of the embryo. Morphologic grading is the most commonly accepted method of establishing embryo quality with several studies reporting a relationship between embryo morphologic quality and pregnancy and live birth [36] . Embryo grade however does not consistently predict normal versus abnormal chromosomal status and thus remains an imperfect method of embryo selection.…”

Section: Embryo Characteristicsmentioning

confidence: 99%

Factors affecting implantation: What really matters?

Mouhanna,

DeCherney

2024

Global Reproductive Health

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Factors affecting embryo implantation, particularly in assisted reproductive technology, remain controversial and poorly understood. Better understanding and optimization of the process of implantation in assisted reproductive technology is important to improving live birth rate and pregnancy outcomes. In this literature review, we examine the key factors involved in implantation and elaborate on current practice, emerging data, and gaps in knowledge.

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Embryo morphologic quality in relation to the metabolic and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection: a matched cohort study

Cited by 8 publications

References 56 publications

Intelligence, motoric and psychological outcomes in children from different ART treatments: a systematic review and meta-analysis

Intelligence, motoric and psychological outcomes in children from different ART treatments: a systematic review and meta-analysis

The risk of asthma in singletons conceived by ART: a retrospective cohort study

Factors affecting implantation: What really matters?

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