Mortality from infancy to adolescence in singleton children conceived from assisted reproductive techniques versus naturally conceived singletons in Sweden

Abstract

Objective: To assess infant (<1 year) and childhood (1-18 years) mortality in singletons conceived through assisted reproductive techniques (ART) versus naturally conceived singletons. Design: Nationwide prospective study. Setting: Sweden. Patient(s): All singleton liveborn infants born from 1983 to 2012 in Sweden identified using the Medical Birth Register (N ¼ 2,847,108), of whom 43,506 were conceived through ART treatments including in vitro fertilization with and without intracytoplasmic sperm injection. Intervention(s): None. Main Outcome Measures(s): Infant (<1 year) and childhood (1-18 years) mortality. Result(s): Data on ART treatment and covariates were retrieved from population-based registers using the unique personal identity number assigned to all permanent residents in Sweden. Cox proportional hazards models estimated the hazard ratios (HRs) with 95% confidence intervals (CIs) as measures of association between ART treatments and death. The analyses were adjusted for maternal characteristics, infertility, child sex, and birth cohort and were restricted to individuals with complete information on covariates for fully adjusted analysis. Compared with naturally conceived singletons, higher infant mortality risks were seen in infants conceived through ART (adjusted HR 1.45; 95% CI, 1.19-1.77), especially after transfer of cryopreserved embryos (adjusted HR 2.30; 95% CI, 1.46-3.64). Early neonatal mortality risk (deaths during the first week) was increased in children born after transfer of blastocysts (HR 2.40; 95% CI, 1. 05-5.48). No increased mortality risk was observed between the ages of 1 and 18 years. Conclusion(s): Singletons conceived through ART had an increased risk of infant mortality from birth up to 1 year of life, predominantly in the early neonatal period and in pregnancies after transfer of frozen and thawed embryos. (Fertil Steril Ò 2020;113:524-32. Ó2019 by American Society for Reproductive Medicine.) El resumen está disponible en Español al final del artículo.

Long-term Follow-up of Psychiatric Disorders in Children and Adolescents Conceived by Assisted Reproductive Techniques in Sweden

“…Whether the findings could be due to a beneficial causal effect or perhaps more plausibly unmeasured confounding, we note that they raise no concerns for the procedures’ potential influence on psychiatric health. In previous contrasts, frozen embryo transfer has appeared more favorable with respect to preterm birth and low birth weight, whereas a recent Swedish study found it associated with higher mortality in the first year of life. We note that as the technology has improved over time, with vitrification replacing slow freezing, so have the indications for use, with elective freeze-all for later transfer being advocated in specific clinical situations.…”

Myths and Controversies in Assisted Reproductive Techniques: Gynecologist's Perspective

“…26 According to another study conducted in February 2020 higher risk for mortality can be seen in children who were conceived by the in vitro fertilization (IVF). 27 There is need to highlight the safety data both for mother and baby in ART among the gynecologist, so that they can better explain it to their patients. There must be more research particularly at local level so that they can better guide and reassure their patients regarding ART.…”

Response to “Outcomes of Very Preterm Infants Conceived with Assisted Reproductive Technologies”

“…In Sweden, for instance, population-based cohort research indicated a higher risk of preterm infant mortality from birth to one year of age in those born as a result of assisted reproductive technology compared with those conceived naturally. 2 As the authors noted, this was a retrospective study, so it is possible that crucial information was overlooked. Although numerous characteristics were given, this study did not focus on several important factors that influence the outcomes of extremely premature children.…”