The health of children conceived by ART: 'the chicken or the egg?'
Sine Berntsen,Viveca Söderström-Anttila,Ulla-Britt Wennerholm,Hannele Laivuori,Anne Loft,Nan B. Oldereid,Liv Bente Romundstad,Christina Bergh,Anja Pinborg +8 more
TLDR
Risks for short- and long-term health in ART singletons are summarized and if the increased health risks are associated with intrinsic maternal or paternal factors related to subfertility or to the ART treatments per se is discussed.Abstract:
Worldwide, more than 7 million children have now been born after ART: these delivery rates are steadily rising and now comprise 2-6% of births in the European countries. To achieve higher pregnancy rates, the transfer of two or more embryos was previously the gold standard in ART. However, recently the practise has moved towards a single embryo transfer policy to avoid multiple births. The positive consequences of the declining multiple birth rates after ART are decreasing perinatal risks and overall improved health for the ART progeny. In this review we summarize the risks for short- and long-term health in ART singletons and discuss if the increased health risks are associated with intrinsic maternal or paternal factors related to subfertility or to the ART treatments per se. Although the risks are modest, singletons born after ART are more likely to have adverse perinatal outcomes compared to spontaneously conceived (SC) singletons dependent on the ART method. Fresh embryo transfer is associated with a higher risk of small for gestational age babies (SGA), low birthweight and preterm birth (PTB), while frozen embryo transfer is associated with large-for-gestational age babies and pre-eclampsia. ICSI may be associated with a higher risk of birth defects and transferral of the poor semen quality to male progeny, while oocyte donation is associated with increased risk of SGA and pre-eclampsia. Concerning long-term health risks, the current evidence is limited but suggests an increased risk of altered blood pressure and cardiovascular function in ART children. The data that are available for malignancies seem reassuring, while results on neurodevelopmental health are more equivocal with a possible association between ART and cerebral palsy. The laboratory techniques used in ART may also play a role, as different embryo culture media give rise to different birthweights and growth patterns in children, while culture to blastocyst stage is associated with PTB. In addition, children born after ART have altered epigenetic profiles, and these alterations may be one of the key areas to explore to improve our understanding of adverse child outcomes after ART. A major challenge for research into adverse perinatal outcomes is the difficulty in separating the contribution of infertility per se from the ART treatment (i.e. 'the chicken or the egg'?). Choosing and having access to the appropriate control groups for the ART children in order to eliminate the influence of subfertility per se (thereby exploring the pure association between ART and child outcomes) is in itself challenging. However, studies including children of subfertile couples or of couples treated with milder fertility treatments, such as IUI, as controls show that perinatal risks in these cohorts are lower than for ART children but still higher than for SC indicating that both subfertility and ART influence the future outcome. Sibling studies, where a mother gave birth to both an ART and a SC child, support this theory as ART singletons had slightly poorer outcomes. The conclusion we can reach from the well designed studies aimed at disentangling the influence on child health of parental and ART factors is that both the chicken and the egg matter.read more
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Autism and Mental Retardation Among Offspring Born After in Vitro Fertilization
TL;DR: In this paper, the authors examined the association between use of any IVF and different IVF procedures and the risk of autistic disorder and mental retardation in the offspring and found that IVF treatment overall was not associated with autistic disorder but was associated with a small but statistically significantly increased risk of mental disorder.
Cancer in children and young adults born after assisted reproductive technology: a Nordic cohort study from the Committee of Nordic ART and Safety (CoNARTaS)
Karin Jerhamre Sundh,Anna-Karina Aaris Henningsen,Karin Källén,Christina Bergh,Liv Bente Romundstad,Mika Gissler,Anja Pinborg,Rolv Skjærven,Aila Tiitinen,Ditte Vassard,Birgitta Lannering,Ulla-Britt Wennerholm +11 more
TL;DR: The main findings are reassuring for couples undergoing ART, children born after ART and clinicians working with ART, and the main limitation is the fact that it is not possible to adjust for all potential confounders.
Journal ArticleDOI
In-utero stress and mode of conception: impact on regulation of imprinted genes, fetal development and future health.
Maria Argyraki,Pauliina Damdimopoulou,Katerina Chatzimeletiou,Grigoris F. Grimbizis,Basil C. Tarlatzis,Maria Syrrou,Alexandros Lambropoulos +6 more
TL;DR: The effect of conception mode and maternal psychological stress on fetal development is highlighted, and a greater understanding of the role of imprinted genes and their regulation in fetal development will provide insights for clinical prevention and management of growth and IDs.
Journal ArticleDOI
The risk of birth defects with conception by ART.
Barbara Luke,Morton B. Brown,Ethan Wantman,Nina E Forestieri,Marilyn L. Browne,Sarah C. Fisher,Mahsa M. Yazdy,Mary K. Ethen,Mark A. Canfield,Stephanie Watkins,Hazel B. Nichols,Leslie V. Farland,Sergio Oehninger,Kevin J. Doody,Michael L. Eisenberg,Valerie L. Baker +15 more
TL;DR: Compared to naturally conceived singleton infants, the risk of a major nonchromosomal defect among ART singletons conceived with autologous oocytes and fresh embryos without use of ICSI was increased by 18%, with increases of 42% and 30% for use ofICSI with and without male factor diagnosis, respectively.
Journal ArticleDOI
The demographics of assisted reproductive technology births in a Nordic country
Alice Goisis,Alice Goisis,Siri E. Håberg,Hans Ivar Hanevik,Maria C. Magnus,Øystein Kravdal,Øystein Kravdal +6 more
TL;DR: Even though in Norway access to ART services is highly subsidised, the results highlight important and persisting social inequities in use of ART and indicate that children born after ART grow up in resourceful environments, which will benefit their development and well-being.
References
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