Assisted reproduction and child neurodevelopmental outcomes: a systematic review

Association Between Assisted Reproductive Technology and Cerebral Palsy: A Meta-Analysis

BACKGROUND

Since 1978 many children are born thanks to assisted reproductive technology (ART). However, the long-term effects of these therapies are still not fully known. Our objective is to evaluate the risk of cerebral palsy (CP) after ART compared with that in those spontaneously conceived (SC) and to examine this risk in single, multiple, and preterm births and the evolution of the risk over the years.

METHODS

PubMed, Embase, and Web of Science databases were searched until December 2022. Studies were included if they studied CP cases in children born through ART. 16 studies were finally selected. Quality of studies was assessed using Newcastle Ottawa Scale. Pooled OR was estimated by weighting individual OR/RR by the inverse of their variance. A random-effect model was applied. To assess the causes of heterogeneity, we performed meta-regression analyses.

RESULTS

A significantly high risk of CP was found (OR = 1.27; 95% CI 1.12 to 1.43) in children born through ART compared with those SC. This risk increased in singletons (OR = 1.48; 95% CI 1.23 to 1.79) but disappeared in multiple (OR = 1.05; 95% CI 0.93 to 1.18) and preterm births (OR = 1.09; 95% CI 0.87 to 1.37). We found a higher risk of CP in children born before the year 2000 (OR = 3.40; 95% CI 2.49 to 4.63).

CONCLUSIONS

ARTs slightly increase the risk of CP once the effect of multiple gestation is controlled. Further studies are needed to clarify whether the techniques themselves, fertility problems, or associated maternal comorbidities are responsible for this risk.

The association between type of conception through medically assisted reproduction and childhood cognition: a Danish population-wide cohort study

BACKGROUND

Previous research has indicated that children conceived through medically assisted reproduction (MAR) generally have cognitive outcomes comparable to or better than naturally conceived children. However, previous studies have been limited in their ability to examine this relationship at a population level and consider variations across different types of MAR.

METHODS

This study utilizes data from all live births in Denmark between 2006 and 2009 (n = 259 608), including a subset of births resulting from MAR conceptions (n = 13 566). The dependent variable is the standardized test scores obtained in the second and third grades of primary schools. A comparison is made between the test scores of children spontaneously conceived (SC) and those conceived through intrauterine insemination (IUI) and assisted reproductive technologies (ART). Ordinary least squares regressions are employed, with a baseline model adjusted only for birth year, as well as models that additionally account for conception-related confounders and sociodemographic family characteristics.

RESULTS

In the baseline analysis, ART- and IUI-conceived children displayed better test scores compared with their SC peers. However, after adjusting for relevant factors, ART-conceived children performed worse than SC peers, while IUI-conceived children performed equally well as SC peers and better than ART-conceived children.

CONCLUSIONS

These results likely reflect differences in the selection process of potential parents into the type of MAR, as well as the consequences of variations in fecundability. Nevertheless, the differences observed across conception types were overshadowed by test score disparities in socioeconomic background.

Long-term outcomes for children conceived by assisted reproductive technology

Worldwide, more than 10 million children have been born after assisted reproduction technology (ART), comprising up to 7.9% of children born in Europe and up to 5.1 % of children born in the US in 2018. The short-term outcome for children born after ART is well-known from numerous publications, with higher rates of preterm birth and low birth weight in children born after fresh embryo transfer and higher rates of large for gestational age and high birth weight in children born after frozen embryo transfer compared with children born after spontaneous conception. Higher rates of birth defects in children born after ART have also been shown consistently over time. Studies on long-term health outcomes after ART are scarcer but suggest an increased risk of altered blood pressure and cardiovascular function in children born after ART. In this review, we summarize long-term health outcomes in children born after ART and discuss whether the increased health risks are associated with intrinsic maternal or paternal factors related to subfertility or ART treatments per se. Finally, we speculate where the future will bring us regarding ART treatment strategies and the safety of the mother and child.

Long-Term Effects of ART on the Health of the Offspring

Assisted reproductive technologies (ART) significantly increase the chance of successful pregnancy and live birth in infertile couples. The different procedures for ART, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), and gamete intrafallopian tube transfer (GIFT), are widely used to overcome infertility-related problems. In spite of its inarguable usefulness, concerns about the health consequences of ART-conceived babies have been raised. There are reports about the association of ART with birth defects and health complications, e.g., malignancies, high blood pressure, generalized vascular functional disorders, asthma and metabolic disorders in later life. It has been suggested that hormonal treatment of the mother, and the artificial environment during the manipulation of gametes and embryos may cause genomic and epigenetic alterations and subsequent complications in the health status of ART-conceived babies. In the current study, we aimed to review the possible long-term consequences of different ART procedures on the subsequent health status of ART-conceived offspring, considering the confounding factors that might account for/contribute to the long-term consequences.

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

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.

Assisted reproductive technology and neurodevelopmental outcomes in offspring: a prospective birth cohort study in East China

RESEARCH QUESTION

Is ART associated with adverse neurodevelopmental outcome in 12-month-old offspring compared with those conceived through natural conception?

DESIGN

In this prospective cohort study, 488 infertile women undergoing ART and 1397 women with natural conception were recruited and followed until their offspring were 12 months old. The primary outcome was the neurodevelopment in the offspring. The association between exposure to ART and Gesell developmental scale scores was investigated using multiple linear regression models after adjusting for confounders. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to verify the results.

RESULTS

In total, 18 (3.7%) and 40 (2.9%) children in the ART and natural conception groups, respectively, had been diagnosed with neurodevelopmental delay at 12 months of age. It was found that gross motor, adaptive behaviour, language and total development quotient scores were comparable between the groups. Following multivariate linear regression and IPTW, social behaviour development quotient scores were found to be slightly higher in the ART group than the natural conception group. Higher social behaviour development quotient scores in the ART group were also observed in the male and the singleton subgroups.

CONCLUSIONS

At 12 months, offspring born after ART appeared to have similar motor, language and adaptive behaviour skills, and total development quotient scores, to those born after natural conception. However, social behaviour development in 12-month-old infants was slightly higher in those conceived using ART than in naturally conceived offspring, especially in male or singleton infants. These findings may provide new information in evaluating the potential benefits and risks of ART.

Perinatal and pediatric outcomes associated with the use of fertility treatment: a population-based retrospective cohort study in Ontario, Canada

BACKGROUND

Around 2% of births in Ontario, Canada involve the use of assisted reproductive technology (ART), and it is rising due to the implementation of a publicly funded ART program in 2016. To better understand the impact of fertility treatments, we assessed perinatal and pediatric health outcomes associated with ART, hormonal treatments, and artificial insemination compared with spontaneously conceived births.

METHODS

This population-based retrospective cohort study was conducted using provincial birth registry data linked with fertility registry and health administrative databases in Ontario, Canada. Live births and stillbirths from January 2013 to July 2016 were included and followed to age one. The risks of adverse pregnancy, birth and infant health outcomes were assessed by conception method (spontaneous conception, ART - in vitro fertilization and non-ART - ovulation induction, intra-uterine or vaginal insemination) using risk ratios and incidence rate ratios with 95% confidence intervals (CI). Propensity score weighting using a generalized boosted model was applied to adjust for confounding.

RESULT(S)

Of 177,901 births with a median gestation age of 39 weeks (IQR 38.0-40.0), 3,457 (1.9%) were conceived via ART, and 3,511 (2.0%) via non-ART treatments. There were increased risks (adjusted risk ratio [95% CI]) of cesarean delivery (ART: 1.44 [1.42-1.47]; non-ART: 1.09 [1.07-1.11]), preterm birth (ART: 2.06 [1.98-2.14]; non-ART: 1.85 [1.79-1.91]), very preterm birth (ART: 2.99 [2.75-3.25]; non-ART: 1.89 [1.67-2.13]), 5-min Apgar < 7 (ART: 1.28 [1.16-1.42]; non-ART: 1.62 [1.45-1.81]), and composite neonatal adverse outcome indicator (ART: 1.61 [1.55-1.68]; non-ART: 1.29 [1.25-1.34]). Infants born after fertility treatments had increased risk of admission to neonatal intensive care unit (ART: 1.98 [1.84-2.13]; non-ART: 1.59 [1.51-1.67]) and prolonged birth admission (≥ 3 days) (ART: 1.60 [1.54-1.65]; non-ART: 1.42 [1.39-1.45]). The rate of emergency and in-hospital health services use within the first year was significantly increased for both exposure groups and remained elevated when limiting analyses to term singletons.

CONCLUSION(S)

Fertility treatments were associated with increased risks of adverse outcomes; however, the overall magnitude of risks was lower for infants conceived via non-ART treatments.

Heavy metals and metalloids exposure and in vitro fertilization: Critical concerns in human reproductive medicine

Exposures to heavy metals and metalloids have been associated with decreased fecundity and fertility in couples conceiving via assisted reproduction. Heavy metals and metalloids can alter the homeostasis of critical hormones controlling sexual maturation by binding to critical hormones and receptors. This may disrupt the time course of sexual maturation directly or indirectly affecting reproductive competence in males and females. The present review aims to provide a summarized overview of associations between heavy metal exposure, reproductive concerns, and IVF outcomes. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) in Google Scholar, Scopus, EMBASE and PubMed databases. Initial search produced 1,351 articles from which 30 articles were eligible to be included in the systematic review. From our results, 16 articles reported associations between selected heavy metals and IVF outcomes, while 14 articles summarized the role of heavy metals in reproductive concerns. For the studies on IVF outcomes, different human samples were examined for heavy metals. Heavy metals and metalloids (Pb, Hg, Cd, Cr, Mn, As) correlated negatively with oocyte fertilization/pregnancy rates in hair, follicular fluid, serum, urine and seminal plasma samples, while Cd and Hg in whole blood samples showed no associations. For the studies on reproductive concerns, high levels of heavy metals/metalloids were implicated in the following conditions: infertility (Cd, Pb, Ba, U), spontaneous abortion/miscarriage (Pb, Cd, Sb), congenital heart disease (Al, Mg, Cd), PCOS (As, Cd, Hg, Pb), endometriosis (Pb) and uterine leiomyomata (Hg). Taken together, the results of our study suggest that the impact of heavy metals and metalloids exposure on reproductive health may contribute to the failure rates of in vitro fertilization.

Fetal neurosonography and infant neurobehavior following conception by assisted reproductive technology with fresh or frozen embryo transfer

OBJECTIVE

We aimed to explore fetal cortical brain development by neurosonography in fetuses conceived by assisted reproductive technology (ART), including frozen and fresh embryo transfer (ET), compared with those conceived spontaneously (SC), and to investigate its association with infant neurobehavior at 12 months of age.

METHODS

This was a prospective cohort study of 210 singleton pregnancies, including 70 SC pregnancies, 70 conceived by in-vitro fertilization (IVF) following frozen ET and 70 conceived by IVF after fresh ET. Fetal neurosonography was performed at 32 ± 2 gestational weeks to assess cortical development. Sulci depths were measured offline and normalized by biparietal diameter (BPD). Ages and Stages Questionnaires (ASQ) were completed postnatally, at 12 ± 1 months of corrected age. Neurosonographic findings were adjusted by regression analysis for maternal age, ethnicity, parity, fetal sex and fetal-weight centile and gestational age at scan, and ASQ scores were adjusted for maternal age, ethnicity, parity, educational level and employment status, gestational age at birth, breastfeeding, infant sex and infant age at the ASQ evaluation.

RESULTS

Overall, in comparison to the SC fetuses, fetuses conceived by ART showed statistically significant differences in cortical development, with reduced parieto-occipital sulci depth adjusted for BPD (mean ± SD: fresh ET, 12.5 ± 2.5 vs frozen ET, 13.4 ± 2.6 vs SC, 13.4 ± 2.6, P < 0.001), cingulate sulci depth adjusted for BPD (median (interquartile range (IQR)): fresh ET, 5.8 (4.2-7.4) vs frozen ET, 5.8 (4.1-7.5) vs SC, 6.5 (4.8-7.8), P = 0.001) and calcarine sulci depth adjusted for BPD (median (IQR): fresh ET, 13.5 (10.1-16.1) vs frozen ET, 14.5 (12.1-15.8) vs SC, 16.4 (14.3-17.9), P < 0.001), together with lower Sylvian fissure grading score. Changes in cortical development were more pronounced in the fresh ET than in the frozen ET group. ART infants showed lower ASQ scores as compared to SC infants, particularly in the fresh ET group (mean ± SD global ASQ Z-score: fresh ET, -0.3 ± 0.4 vs frozen ET, -0.2 ± 0.4 vs SC, 0 ± 0.4, P < 0.001).

CONCLUSIONS

Fetuses conceived by ART show a distinctive pattern of cortical development and suboptimal infant neurodevelopment, with more pronounced changes in those conceived following fresh ET. These findings support the existence of in-utero brain reorganization associated with ART and warrant follow-up studies to assess its long-term persistence. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Male personal heat exposures and fecundability: A preconception cohort study

BACKGROUND

Several studies indicate adverse effects of selected heat exposures on semen quality, but few studies have directly evaluated fertility as an endpoint.

OBJECTIVE

We evaluated prospectively the association between male heat exposures and fecundability, the per-cycle probability of conception.

MATERIALS AND METHODS

We analyzed data from 3041 couples residing in the United States or Canada who enrolled in a prospective preconception cohort study (2013-2021). At enrollment, males reported on several heat-related exposures, such as use of saunas, hot baths, seat heaters, and tight-fitting underwear. Pregnancy status was updated on female follow-up questionnaires every 8 weeks until conception or a censoring event (initiation of fertility treatment, cessation of pregnancy attempts, withdrawal, loss to follow-up, or 12 cycles), whichever came first. We used proportional probabilities regression models to estimate fecundability ratios (FR) and 95% confidence intervals (CIs) for the association between heat exposures and fecundability, mutually adjusting for heat exposures and other potential confounders.

RESULTS

We observed small inverse associations for hot bath/tub use (≥3 vs. 0 times/month: FR = 0.87, 95% CI: 0.70-1.07) and fever in the 3 months before baseline (FR = 0.94, 95% CI: 0.79-1.12; one cycle of follow-up: FR = 0.84, 95% CI: 0.64-1.11). Little association was found for sauna use, hours of laptop use on one's lap, seat heater use, time spent sitting, and use of tight-fitting underwear. Based on a cumulative heat metric, FRs for 1, 2, 3, and ≥4 versus 0 heat exposures were 0.99 (95% CI: 0.87-1.12), 1.03 (95% CI: 0.89-1.19), 0.94 (95% CI: 0.74-1.19), and 0.77 (95% CI: 0.50-1.17), respectively. Associations were stronger among men aged ≥30 years (≥4 vs. 0 heat exposures: FR = 0.60, 95% CI: 0.34-1.04).

CONCLUSION

Male use of hot tubs/baths and fever showed weak inverse associations with fecundability. Cumulative exposure to multiple heat sources was associated with a moderate reduction in fecundability, particularly among males aged ≥30 years.

Parental fecundability and neurodevelopmental delays and difficulties in offspring

BACKGROUND

Impaired neurodevelopment is reported among children conceived by assisted reproductive technologies (ART). However, this might be explained by conditions underlying parental subfecundity, rather than the ART procedure.

METHODS

We examined associations of parental time-to-pregnancy (TTP) and conception by ART with neurodevelopmental traits up to 8 years of age, including motor and language skills, social delays and difficulties, and inattention-hyperactivity, among 92 142 singletons participating in the Norwegian Mother, Father and Child Cohort Study (MoBa). Mothers reported TTP and neurodevelopmental traits through questionnaires. Mean differences in standardized neurodevelopmental traits were estimated using linear regression, adjusting for maternal age, parity, educational level, body mass index and smoking, and paternal age.

RESULTS

A longer TTP was associated with decreased language skills and motor skills at 6, 18 and 36 months (P-values for trend ≤0.01), prosocial skills delay at 36 months (P-values for trend ≤0.001) and increased scores for inattention-hyperactivity traits at all ages up to 8 years (P-values for trend from 0.06 to 0.01). Effect sizes were small, ranging between 0.03 and 0.05 difference in the standardized neurodevelopmental scores. Estimates for ART were imprecise, but there were no differences between children conceived by ART and naturally conceived children of subfecund parents (TTP ≥12 months).

CONCLUSIONS

Longer parental TTP is modestly but robustly associated with offspring neurodevelopmental delays and difficulties, with no added impact of ART. Future studies should investigate the underlying causes of-or aspects related to-parental subfecundity which might explain the association with offspring neurodevelopmental delays and difficulties.

Semen quality and reproductive hormones in sons of subfertile couples: a cohort study

OBJECTIVE

To study the associations between parental subfecundity, assessed by time to pregnancy and use of medically-assisted reproduction, and reproductive health of young men.

DESIGN

Cohort study.

SETTING

Denmark.

PATIENT(S)

A total of 1,058 men in the Fetal Programming of Semen quality cohort, a subcohort of the Danish National Birth Cohort.

INTERVENTION(S)

From 2017-2019, men were recruited and provided semen and blood samples. Information on parental time to pregnancy and use of medically-assisted reproduction (including type of treatment) as well as demographic, health, and lifestyle factors were available. We estimated the crude and adjusted relative percentage differences with 95% confidence intervals (CIs) in the outcomes according to time to pregnancy and use of medically-assisted reproduction, using multiple adjusted negative binomial regression analysis.

MAIN OUTCOME MEASURE(S)

Semen characteristics (semen volume, sperm concentration, total sperm count, sperm motility, and morphology), testicular volume, and reproductive hormone levels (follicle stimulating hormone, luteinizing hormone, testosterone, estradiol, sex hormone-binding globulin, and free androgen index).

RESULT(S)

Overall, semen quality and levels of reproductive hormones were not lower among sons of subfecund parents reporting a time to pregnancy >6 months or use of intrauterine insemination. Sons conceived after in vitro fertilization or intracytoplasmic sperm injection, had a higher semen concentration (29%; 95% CI, -7%-79%) and a higher percentage of sperm with normal morphology (20%; 95% CI, -8%-56%), but with 95% CI overlapping the null. Moreover, these sons had slightly higher estradiol levels (30%; 95% CI, 7%-57%). The absolute differences seen were small, and the clinical significance of these differences are unknown.

CONCLUSION(S)

We found no major difference in semen quality or reproductive hormones in sons conceived by subfertile couples or with the use of medically-assisted reproduction.

Jiawei Runjing Decoction Improves Spermatogenesis of Cryptozoospermia With Varicocele by Regulating the Testicular Microenvironment: Two-Center Prospective Cohort Study

Objective: The aim of the study was to explore the evidence of JWRJD in the treatment of cryptozoospermia.

Methods: A total of 162 cryptozoospermia patients with varicocele who refused to undergo surgery were included from January 2021 to December 2021. They were divided into the Jiawei Runjing Decoction group (group A), tamoxifen group (group B), and no treatment group (group C), and after the follow-up for 3 months, therapeutic effectiveness was compared. Network pharmacology was used to analyze and validate the effects and mechanisms of JWRJD.

Results: Fifty-eight patients were treated with JWRJD, 55 with tamoxifen, and 49 without any treatment. After treatment, five patients were lost: one in group A, one in group B, and three in group C. The sperm count and the decrease of FSH in group A were significantly higher, but the degree of decline in the testicular volume and the degree of vein expansion have decreased significantly, which were closely related to the testicular volume (TV) [especially changes in the left testicular volume (ΔL-TV)], citric acid (CC) and its changes (ΔCC), and the vein width (VW) [especially left spermatic vein width (L-VW) and mean vein width (M-VW) and their changes (ΔL-VW and ΔM-VW)], as well as the sperm count before the treatment (bSC), which were the significant indexes to predict the therapeutic effect, especially for patients >35 years old and with grade III varicoceles. Network pharmacological analysis verifies that it can be regulated by fluid shear stress and the atherosclerosis pathway to improve the testicular microenvironment for spermatogenesis.

Conclusion: JWRJD may promote spermatogenesis in cryptozoospermia patients with varicocele, which may be closely related to improving the testicular microenvironment, especially for >35 year olds and grade III varicocele patients.

Assisted reproductive technology and childhood morbidity: a longitudinal cohort study

OBJECTIVE

To evaluate the association between assisted reproductive technology (ART) and offspring morbidity in the first decade of life.

DESIGN

Longitudinal cohort study.

SETTING

Provincial health registry in Quebec, Canada.

PATIENT(S)

A total of 797,654 singleton children born between 2008 and 2019, followed up to 2020.

INTERVENTION(S)

Retrospective, noninterventional study of any ART procedure vs. no ART.

MAIN OUTCOME MEASURE(S)

Childhood morbidity, including hospitalization for infectious, allergic, malignant, and other diseases, assessed using adjusted Cox proportional hazards regression to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for the association with ART. We controlled for unmeasured family-level confounders that were shared among siblings through stratified Cox regression. To do so, we restricted the analysis to 10,097 siblings with discordant exposure to ART and compared the risk of outcomes in exposed vs. unexposed siblings.

RESULT(S)

Compared with no ART, ART was associated with 1.23 times the risk of any hospitalization (95% CI 1.19-1.27), 1.25 times the risk of infectious disease hospitalization (95% CI 1.21-1.29), and 1.25 times the risk of allergy hospitalization (95% CI 1.14-1.38). When we used a sibling design to control for shared genetic and environmental confounders, ART was not associated with a greater risk of childhood hospitalization (HR 0.92, 95% CI 0.78-1.08).

CONCLUSION(S)

ART is associated with an elevated risk of hospitalization up to 11 years of age, but discordant sibling analysis suggests that the association may be due to genetic, environmental, or other shared familial confounders.

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

BACKGROUND

Embryos with higher morphologic quality grading may have a greater potential to achieve clinical pregnancy that leads to a live birth regardless of the type of cleavage-stage embryos or blastocysts. Few studies have investigated the impacts of embryo grading on the long-term health of the offspring.

OBJECTIVE

This pilot study aimed to examine the associations between embryo morphologic quality and the physical, metabolic, and cognitive development of singletons conceived by in vitro fertilization and intracytoplasmic sperm injection at preschool age.

STUDY DESIGN

This matched cohort study included singletons born to infertile couples who underwent fresh cleavage-stage embryo transfer cycles with good- or poor-quality embryos from 2014 to 2016 at the reproductive center of the Women's Hospital, School of Medicine, Zhejiang University. A total of 144 children, aged 4 to 6 years, participated in the follow-up assessment from 2020 to 2021, and the response rate of poor-quality embryo offspring was 39%. Singletons in the good-quality embryo group were matched with singletons in the poor-quality embryo group at a 2:1 ratio according to the fertilization method and the children's age (±1 year). We measured the offspring's height, weight, body mass index, blood pressure, thyroid hormone levels, and metabolic indicators. Neurodevelopmental assessments were performed using the Chinese version of the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition, and the Adaptive Behavior Assessment System, Second Edition. We also collected data from the medical records. A linear regression model was used to analyze the association between embryo morphologic quality and offspring health outcomes.

RESULTS

A total of 48 singletons conceived with poor-quality embryo transfer and 96 matched singletons conceived with good-quality embryo transfer were included in the final analysis. Age, sex, height, weight, body mass index, blood pressure, thyroid function, and metabolic indicators were comparable between the 2 groups. After adjustment for potential risk factors by linear regression model 1 and model 2, poor-quality embryo offspring exhibited a tendency toward higher free thyroxine levels than offspring of good-quality embryo transfers (beta, 0.22; 95% confidence interval, 0.09-0.90; beta, 0.22; 95% confidence interval, 0.09-0.91, respectively), but this difference was not clinically significant. Regarding neurodevelopmental assessments, there was no difference in the full-scale intelligence quotient based on the Wechsler Preschool and Primary Scale of Intelligence (109.96±12.42 vs 109.60±14.46; P=.88) or the general adaptive index based on the Adaptive Behavior Assessment System (108.26±11.70 vs 108.08±13.44; P=.94) between the 2 groups. The subindices of the 2 tests were also comparable. These findings remained after linear regression analysis.

CONCLUSION

At 4 to 6 years of age, singletons born from poor-quality embryo transfers have comparable metabolic and cognitive development as those born from good-quality embryo transfers using fresh cleavage-stage embryos. The results of this pilot study indicate that poor-quality embryos that can survive implantation and end in live birth are likely to have a developmental potential comparable to that of good-quality embryos.

Effect of medically assisted reproduction (MAR) and pregnancy planning on Bayley-III Screening Test subscales in preterm infants at 12 months of corrected age: a cross-sectional study

Background

The association between medically assisted reproduction and pregnancy planning on overall developmental outcomes of infants has been studied in relatively few studies. The availability of accurate tools for the early detection of developmental delays is a major issue. The purpose of this study is describing the average neurodevelopment of preterm infants and assessing the association between medically assisted reproduction, pregnancy planning and neurodevelopmental outcomes among Hungarian preterm infants.

Methods

Cross-sectional study of preterm infants with gestational age < 37 weeks (N = 171) who underwent developmental assessment using Bayley-III Screening Test (Bayley Scales of Infant and Toddler Development Screening Test – Third Edition) in five developmental domains (cognitive, receptive and expressive language, fine and gross motor) at 12 months of corrected age. We examined the developmental pattern of infants and the potential associations between medically assisted reproduction, pregnancy planning and Bayley-III Screening Test subscales. Information on the mode of conception and pregnancy planning was obtained through parental anamnesis.

Results

Concerning the risk for developmental delay, the language and motor subscales were the most affected. Examination of the mode of conception and developmental outcomes revealed higher neurodevelopmental skills in infants who were conceived through medically assisted reproduction. Significantly lower cognitive, receptive and expressive language skills were found to be associated with unplanned pregnancies. Multi-way analysis of variance was conducted in order to assess the impact of the mode of conception and pregnancy planning on subscales.

Conclusions

We cannot unambiguously conclude that MAR and pregnancy planning had a solely positive effect on the development of preterm infants at 12 months of corrected age, but our results are vital for the design and implementation of further research.

Neurological development in 36‐month‐old children conceived via assisted reproductive technology: The Japan Environment and Children's Study

Purpose

This study aimed to investigate neurodevelopment in children conceived via in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) with several types of embryo transfers.

Methods

We analyzed data for 77 928 children and their mothers included in a Japanese birth cohort study. Among the included children, 4071 were conceived via IVF, while 1542 were conceived via ICSI. Neurodevelopmental delay at the age of 3 years was assessed using the Japanese version of the Ages and Stages Questionnaires, 3rd edition.

Results

In the crude model, the odds ratios for developmental delay in 1–4 domains were higher among children conceived via IVF, ICSI, and non‐ART (ovulatory induction or intrauterine insemination) than in spontaneously conceived children. After adjusting for parental background factors and the child's sex, there were no differences in the risk of developmental delay when comparing singletons conceived by IVF, ICSI, or non‐ART and those conceived spontaneously. Higher odds ratios for developmental delay in one domain were observed in singleton girls conceived via IVF when compared with those who were spontaneously conceived.

Conclusion

Most cases of developmental delay may be associated with multiple pregnancies and factors related to infertility, such as parental age, irrespective of the use of ART.

Association between polycystic ovary syndrome and risk of attention-deficit/hyperactivity disorder in offspring: a meta-analysis

BACKGROUND

There is evidence of a relationship between prenatal excess androgen exposure and central nervous developmental problems and attention-deficit/hyperactivity disorder (ADHD) in the offspring of mothers with polycystic ovary syndrome (PCOS).

PURPOSE

Here we aimed to use a meta-analysis to investigate whether the offspring of mothers with PCOS are at an increased chance of developing ADHD.

METHODS

Three main English databases were searched for articles published through December 2020. The NewcastleOttawa Scale was used to assess study quality. Study heterogeneity was determined using <italic>I</italic>2 statistics and publication bias was assessed using Begg and Egger tests. The results are presented as odds ratio (OR) and relative ratio (RR) estimates with 95% confidence intervals (CIs) using a random-effects model.

RESULTS

Six articles (3 cohort and 3 case-control studies; 401,413 total ADHD cases) met the study criteria. Maternal PCOS was associated with an increased risk of ADHD in the offspring based on OR and RR (OR, 1.42; 95% CI, 1.27-1.57) and (RR, 1.43; 95% CI, 1.35-1.51), respectively. There was no heterogeneity among the included articles based on OR (<italic>I</italic>2=0.0%, P=0.588) and RR (<italic>I</italic>2=0.0%, P=0.878).

CONCLUSION

Our study showed that maternal PCOS is a risk factor for ADHD. Therefore, screening their offspring for ADHD should be considered part of the comprehensive clinical care of women with PCOS.

Neurodevelopmental outcomes of preterm infants conceived by assisted reproductive technology

BACKGROUND

There have been concerns about the development of children conceived through assisted reproductive technology. Despite multiple studies investigating the outcomes of assisted conception, data focusing specifically on the neurodevelopmental outcomes of infants conceived through assisted reproductive technology and born preterm are limited.

OBJECTIVE

This study aimed to evaluate and compare the neurodevelopmental outcomes of preterm infants born at <29 weeks' gestation at 18 to 24 months' corrected age who were conceived through assisted reproductive technology and those who were conceived naturally.

STUDY DESIGN

This retrospective cohort study included inborn, nonanomalous infants, born at <29 weeks' gestation between January 1, 2010, and December 31, 2016, who had a neurodevelopmental assessment at 18 to 24 months' corrected age at any of the 10 Canadian Neonatal Follow-Up Network clinics. The primary outcome was neurodevelopmental impairment at 18 to 24 months, defined as the presence of any of the following: cerebral palsy; Bayley-III cognitive, motor, or language composite score of <85; sensorineural or mixed hearing loss; and unilateral or bilateral visual impairment. Secondary outcomes included mortality, composite of mortality or neurodevelopmental impairment, significant neurodevelopmental impairment, and each component of the primary outcome. We compared outcomes between infants conceived through assisted reproductive technology and those conceived naturally, using bivariate and multivariable analyses after adjustment.

RESULTS

Of the 4863 eligible neonates, 651 (13.4%) were conceived using assisted reproductive technology. Maternal age; education level; and rates of diabetes mellitus, receipt of antenatal corticosteroids, and cesarean delivery were higher in the assisted reproduction group than the natural conception group. Neonatal morbidity and death rates were similar except for intraventricular hemorrhage, which was lower in the assisted reproduction group (33% [181 of 546] vs 39% [1284 of 3318]; P=.01). Of the 4176 surviving infants, 3386 (81%) had a follow-up outcome at 18 to 24 months' corrected age. Multivariable logistic regression adjusting for gestational age, antenatal steroids, sex, small for gestational age, multiple gestations, mode of delivery, maternal age, maternal education, pregnancy-induced hypertension, maternal diabetes mellitus, and smoking showed that infants conceived through assisted reproduction was associated with lower odds of neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.52-0.86) and the composite of death or neurodevelopmental impairment (adjusted odds ratio, 0.67; 95% confidence interval, 0.54-0.84). Conception through assisted reproductive technology was associated with decreased odds of a Bayley-III composite cognitive score of <85 (adjusted odds ratio, 0.68; 95% confidence interval, 0.48-0.99) and composite language score of <85 (adjusted odds ratio, 0.67; 95% confidence interval, 0.50-0.88).

CONCLUSION

Compared with natural conception, assisted conception was associated with lower odds of adverse neurodevelopmental outcomes, especially cognitive and language outcomes, at 18 to 24 months' corrected age among preterm infants born at <29 weeks' gestation. Long-term follow-up studies are required to assess the risks of learning disabilities and development of complex visual-spatial and processing skills in these children as they reach school age.

Increased Risk of ADHD at Short and Long Interpregnancy Intervals in a National Birth Cohort

BACKGROUND

Short or long interpregnancy interval (IPI) may adversely impact conditions for foetal development. Whether attention deficit hyperactivity disorder (ADHD) is related to IPI has been largely unexplored.

OBJECTIVES

To examine the association between IPI and ADHD in a large, population-based Finnish study.

METHODS

All children born in Finland between 1991 and 2005 and diagnosed with ADHD (ICD-9 314x or ICD-10 F90.x) from 1995 to 2011 were identified using data from linked national registers. Each subject with ADHD was matched to 4 controls based on sex, date of birth, and place of birth. A total of 9564 subjects with ADHD and 34,479 matched controls were included in analyses. IPI was calculated as the time interval between sibling birth dates minus the gestational age of the second sibling. The association between IPI and ADHD was determined using conditional logistic regression and adjusted for potential confounders.

RESULTS

Relative to births with an IPI of 24 to 59 months, those with the shortest IPI (<6 months) had an increased risk of ADHD (odds ratio [OR] 1.30, 95% confidence interval (CI) 1.12, 1.51) and the ORs for the longer IPI births (60-119 months and ≥120 months) were 1.12 (95% CI 1.02, 1.24) and 1.25 (95% CI 1.08, 1.45), respectively. The association of longer IPI with ADHD was attenuated by adjustment for maternal age at the preceding birth, and comorbid autism spectrum disorders did not explain the associations with ADHD.

CONCLUSIONS

The risk of ADHD is higher among children born following short or long IPIs although further studies are needed to explain this association.

School performance in children born after ICSI

STUDY QUESTION

Do children conceived after ICSI have similar school performance as children born after IVF?

SUMMARY ANSWER

Children born after ICSI have similar school performance compared to children born after IVF.

WHAT IS KNOWN ALREADY

Studies concerning the cognitive skills of children born after ICSI have shown diverging results.

STUDY DESIGN, SIZE, DURATION

This nationwide, register-based cohort study included all singleton children born after ICSI (n = 6953), IVF (n = 11 713) or spontaneous conception (SC) (n = 2 022 995), in Sweden between 1985 and 2006.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Singleton children born after ICSI were identified in national IVF registers, cross-linked with the Medical Birth Register (MBR), the National Patient Register (NPR) and the Swedish Cause of Death Register (CDR) for characteristics and medical outcomes. Data on school performance, parental education and other parental characteristics were obtained through cross-linking to the National School Registry and to Statistics Sweden. The main control group, which consisted of children born after IVF, was identified in the national IVF registries while the second control group, consisting of children born after SC, was identified from the MBR. Simple and multivariable linear regression was used for analysis of continuous variables, and logistic regression was used for the analysis of binary outcomes. Adjustments were made for sex, year of birth, maternal smoking during pregnancy, parental age, parity, parental region of birth, parental level of education and frozen embryo transfer.

MAIN RESULTS AND THE ROLE OF CHANCE

In the adjusted analyses, there was no significant difference between ICSI and IVF children for total score (adjusted odds ratios (AORs) 1.03; 95% CI −0.22 to 2.28; P = 0.11), specific subjects, qualifying for secondary school (AOR 1.02; 95% CI 0.82–1.26; P = 0.87) or poor school performance (AOR 0.92; 95% CI 0.75−1.14; P = 0.47). In the third grade, children born after ICSI had a significantly lower chance of passing all of the subtests in Mathematics (AOR 0.89; 0.83–0.96; P = 0.002) and Swedish (AOR 0.92; 0.85–0.99; P = 0.02) compared to children born after SC. When cross-linking children with missing data on school performances (2.1% for ICSI, 2.0% for IVF and 2.3% for SC) with the Cerebral Palsy Follow-up Register (CPUP) for cerebral palsy, 2.7% of ICSI children, 5.7% of IVF children and 1.7% of SC children without registered education were found. When cross-linking children with missing data on school performances with the NPR for mental retardation, 29.9% of ICSI children, 32.6% of IVF children and 35.0% of SC children with missing data were registered under such a diagnosis.

LIMITATIONS, REASONS FOR CAUTION

The main limitation was that test scores were missing in a small percentage in both ICSI and IVF children. Although we were able to cross-link this subpopulation with the CPUP and the NPR, these diagnoses only partly explained the missing scores. Other limitations were unmeasured and unknown possible confounders, such as information about infertility diagnoses and indication for ICSI, were not available.

WIDER IMPLICATIONS OF THE FINDINGS

These findings are important to most countries where IVF and ICSI are used since there may be differences in choice of procedure. In recent years, there has been an increasing trend towards using ICSI not only for treatment of male infertility but also when the sperm quality is normal. Our results indicate that the school performance of children born after ICSI is reassuring.

STUDY FUNDING/COMPETING INTEREST(S)

Financial support was received through Sahlgrenska University Hospital (ALFGBG – 70 940), Hjalmar Svensson Research Foundation and Nordforsk, project number 71 450. None of the authors declare any conflict of interest.

TRIAL REGISTRATION NUMBER

N/A

Cognitive achievements in school-age children born following assisted reproductive technology treatments: A prospective study

BACKGROUND

While assisted reproductive technology is increasingly prevalent, there is concern amid conflicting findings reported regarding the long-term outcomes of children born following these treatments. The aim of this research was to investigate aspects of cognitive development in early school-age Israeli children born following assisted reproductive technology (ART) treatments, compared to those spontaneously conceived (SC).

METHOD

This prospective follow-up study was based on an Israeli cohort recruited from June 2006 to December 2008, that included 561 women whose pregnancies were achieved by ART treatments and 600 women whose pregnancies were SC. When the children were 7-8 years old, 759 of their mothers were interviewed by telephone, and 294 were came for developmental assessment. The examination included: Kaufman Brief Intelligence Test; Kaufman Assessment Battery for Children (arithmetic only); Test of Everyday Attention for Children; Beery-Buktenica Developmental Test of Visual-Motor Integration and Supplemental Test for Visual Perception; Rey-Osterrieth Complex Figure Test; Aleph-ad-Tav Hebrew reading and writing; Tavor Picture Naming Expressive Vocabulary Test. Multivariable analyses were adjusted for maternal years of education (≤12, 13+) at child's birth and child's sex.

RESULTS

Cognitive function, visual-motor ability, attention, and verbal skills of children born after ART treatments were similar to those of SC children, upon both univariate and multivariable analysis.

CONCLUSION AND IMPLICATIONS

No significant differences were found between the ART and SC groups on any of the measures examined. This finding offers couples seeking ART treatments improved information regarding child development during the important and formative school years.

WHAT THIS PAPER ADDS

Increasing rates of ART treatments arouse concern about long-term outcomes for offspring, and conflicting findings have been reported with respect to the skills necessary to their academic success. This prospective follow-up study compared school-age children born following ART with spontaneously-conceived children. Children were examined by developmental psychologists, and cognitive function, visual-motor, attention, verbal, and performance skills were similar in both groups.

The cognitive development from childhood to adolescence of low birthweight children born after medically assisted reproduction-a UK longitudinal cohort study

Background

Previous research has documented that children conceived through medically assisted reproduction (MAR) are at increased risk of poor birth outcomes, such as low birthweight (LBW), which are risk factors for stunted longer-term cognitive development. However, parents who undergo MAR to conceive have, on average, advantaged socioeconomic backgrounds which could compensate for the negative effects of being born LBW. Previous studies have not analysed whether the negative effects of LBW are attenuated among MAR conceived children.

Methods

We draw on the UK Millennium Cohort Study (sweeps 1–6) which contains a sub-sample of (N = 396) MAR-conceived children. The dependent variable measures cognitive ability at around ages 3, 5, 7, 11 and 14. We examine the cognitive development of four groups of children: MAR-conceived low birthweight (MAR LBW); MAR-conceived non-low birthweight (MAR NLBW); naturally conceived low birthweight (NC LBW); naturally conceived non-low birthweight (NC NLBW). We estimate the two following linear regression models for each sweep: (i) a baseline model to examine the unadjusted association between cognitive development and low birthweight by mode of conception; and (ii) a model adjusted by socio-demographic family characteristics.

Results

In baseline models, MAR LBW children [age 3: β  =  0.021, 95% confidence interval (CI): -0.198, 0.241; age 5: β  =  0.21, 95% CI: 0.009, 0.418; age 7: β  =  0.163, 95% CI: -0.148, 0.474; age 11: β  =  0.003, 95% CI: -0.318, 0.325; age 14: β  =  0.156, 95% CI: -0.205, 0.517], on average perform similarly in cognitive ability relative to NC NLBW at all ages, and display higher cognitive scores than NC LBW children until age 7. When we account for family characteristics, differences are largely attenuated and become close to zero at age 14.

Conclusions

Despite the higher incidence of LBW among MAR compared with NC children, they do not seem to experience any disadvantage in their cognitive development compared with naturally conceived children. This finding is likely explained by the fact that, on average, MAR children are born to socioeconomically advantaged parents.

How Are They Doing? Neurodevelopmental Outcomes at School Age of Children Born Following Assisted Reproductive Treatments

OBJECTIVE

The purpose of this study was to assess major neurodevelopmental aspects of children conceived by assisted reproductive treatments compared to spontaneously conceived children during the early school years.

MATERIAL & METHODS

In this follow-up study, mothers of 358 children born following assisted reproductive treatments and 401 spontaneously-conceived children were interviewed by telephone regarding their children's health and development, when the children were 7-8 years old. The main outcomes were maternal responses to 4 questionnaires: Developmental Coordination Disorder Questionnaire, Short Sensory Profile, Autism Spectrum Screening Questionnaire, and the Attention-deficit hyperactive disorder (ADHD) Child Symptom Inventory-4 subscale. Mothers reported diagnoses of ADHD and autism spectrum disorder.

RESULTS

No significant differences were found between the groups in Developmental Coordination Disorder Questionnaire or Short Sensory Profile scores upon univariate or multivariable analyses. There was a slightly higher but nonsignificant rate of diagnosed ADHD among children in the assisted reproductive treatment group (9.6% vs 5.5%; P = .18); on multivariable analysis, a nonsignificant increase in ADHD was also found for assisted reproductive treatment children (hazard ratio 1.45, 95% confidence interval 0.81-2.61). Regarding the Child Symptom Inventory-4 criteria for ADHD among the children who had never been diagnosed, there was also a slightly higher but nonsignificant rate among the assisted reproductive treatments compared to spontaneously-conceived children on univariate (2.4% vs 1.8%; P = .50) and multivariable analysis (odds ratio 0.88, 95% confidence interval 0.27-2.86). Autism spectrum disorder diagnosis or Autism Spectrum Screening Questionnaire scores were not significantly different; however, 5 of the 6 children with autism spectrum disorder diagnoses were in the assisted reproductive treatment group.

CONCLUSIONS

Neurodevelopmental measures were similar in both groups, although nonconclusive regarding ADHD and autism spectrum disorder risk. These findings contribute to the knowledge regarding long-term assisted reproductive treatment outcomes.

Ninth-grade school achievement in Danish children conceived following fertility treatment: a population-based cohort study

OBJECTIVE

To assess whether academic achievement among children conceived following fertility treatment is different from that of children born to fertile women while also considering the underlying infertility.

DESIGN

Population-based cohort study.

SETTING

Denmark.

PATIENT(S)

The study population consisted of all 154,536 firstborn, live-born, singleton children in Denmark between 1995 and 2000 who completed their ninth grade with an examination.

INTERVENTION(S)

The Danish Infertility Cohort was used to identify children conceived after fertility treatment (n = 10,099), and information on mean school marks was obtained from Statistics Denmark.

MAIN OUTCOME MEASURE(S)

Linear regression models were used to estimate mean differences (MDs) and 95% confidence intervals (CIs). Multiple logistic regression models were used to estimate odds ratios (OR) and 95% CI of not passing the ninth-grade examination.

RESULTS

The crude overall mean marks for children conceived after the various fertility treatment procedures were in general higher than in children born to fertile women. However, after adjustment for potential confounders, the overall mean marks were statistically significantly lower for children conceived after the various fertility treatment procedures (e.g., any fertility treatment: MD -0.13; 95% CI -0.18, -0.08) compared with children born to fertile women. Further, children conceived after any fertility treatment had a statistically significant lower crude likelihood of not passing the ninth-grade examination (OR 0.66; 95% CI 0.53, 0.81) compared with children born to fertile women, whereas no difference was observed in the confounder adjusted analyses (OR 1.15; 95% CI 0.89, 1.49). When children born to women requiring fertility assistance but without fertility treatment in the index pregnancy were used as a reference group, no differences in the adjusted overall mean marks and the likelihood of not passing the ninth grade with an examination were observed.

CONCLUSION

Our findings indicate that fertility treatment per se is not associated with lower school marks and the likelihood of not passing the ninth grade with an examination. Hence, we suggest that factors related to both fertility problems and cognitive development may more likely explain the slightly lower academic performance (i.e., modest lower mean marks) among children conceived after fertility treatment.

Health and Well-Being Outcomes of Adolescents Conceived Through In Vitro Fertilization and Intracytoplasmic Sperm Injection

What is the perception of health and well-being of adolescents from an assisted reproductive technology (ART) cohort? We conducted a survey, from September 2015 to June 2016, through self-completion questionnaires, on 487 singleton or twin ART-conceived 11- to 15-year-old adolescents, followed up since 1994, as part of an ART cohort. Collected data concerned perinatal characteristics, health indicators and perception, eating habits, behavior, and living standards. A total of 60.6% of the questionnaires were returned and could therefore be analyzed. This concerned 295 adolescents who were representative of the 788 remaining adolescents of our cohort, in terms of type of ART, maternal and perinatal characteristics, but not gender (sex ratio = 0.77). Overall, 15.3% reported chronic diseases, and only 13.3% of them considered that their chronic disease had an impact on their school life. Moreover, 94.2% of adolescents perceived that their health was "excellent" or "good"; 97.3% adolescents had normal weight or were underweight; onset of menstruation was 12 years old (± 1) for girls, age usually reported for puberty in girls; 51.9% declared having regular physical activity, boys more frequently than girls. Moreover, 70.6% of the boys had a sedentary behavior compared to 44.8% of the girls. A total of 73.5% of the adolescents were stressed at school, but school demand was considered high only in 12.2% of cases. Finally, 90% declared to have high life satisfaction. Overall, ART does not appear to have particular effect on the health indicators and behavior of adolescents who participated in the survey except for higher family affluence scale.

Is Intracytoplasmic Sperm Injection the Solution for all in Unexplained Infertility?

Intracytoplasmic sperm injection (ICSI) was first introduced as a supplemental method to conventional in vitro fertilization (c-IVF) for couples with severe male factor infertility to overcome the poor fertilization rate, while its indications expanded in current clinical practice and gained worldwide popularity. However, ICSI is invasive and crosses all natural barriers, raising several unresolved concerns regarding procedure-dependent and procedure-independent risks, as well as the characteristic of being labor-intensive and more expensive than c-IVF. This review is aimed to draw readers' attention, to the widespread use of ICSI worldwide, with its effectiveness in different indications of infertility, especially in those with unexplained infertility, as well as the cost-effectiveness of the ICSI-for-all strategy. Also, we covered current evidence on the short- and long-term safety of children born thanks to ICSI-aided conception. Further well-designed, adequately powered, and randomized controlled clinical trials are absolutely needed to arrive at a consensus on the use of ICSI over c-IVF in different populations.

Motor behaviour in infancy is associated with neurological, cognitive, and behavioural function of children born to parents with reduced fertility

AIM

To evaluate the associations between motor development in infancy and developmental outcomes at school age.

METHOD

Participants were 195 children (99 males, 96 females; mean age [SD] 9y 3mo [3mo], range 8y 4mo-10y 11mo) born to couples whose reduced fertility was or was not treated with assisted reproductive technologies. Motor behaviour was assessed at 4, 10, and 18 months with the Infant Motor Profile (IMP). IQ, neurological optimality score (NOS), and behavioural problem scores were measured at 9 years with the Wechsler Abbreviated Scale of Intelligence, minor neurological dysfunction assessment, and the Child Behavior Checklist respectively.

RESULTS

Children with a slow developmental trajectory in the IMP-domain adaptability had an IQ 12.6 points lower (95% confidence interval [CI] 4.7-20.4) and an NOS 3.4 points lower (95% CI 0.7-6.2) at 9 years of age than children with typical adaptability development. Children with a slow developmental trajectory in the IMP-domain performance had an IQ 5.0 points lower (95% CI 0.7-9.3) than children with typical performance development. A non-optimal trajectory in IMP-variation and a fluctuating trajectory in IMP-fluency were associated with higher internalizing scores of 3.6 and 5.8 points respectively, than infants with optimal IMP-domain trajectories.

INTERPRETATION

In relatively low-risk children, motor behaviour in infancy was associated with neurological, cognitive, and behavioural function at school age.

Diminished verbal ability among children conceived through ART with exposure to high serum estradiol in utero

Purpose

Higher serum estradiol levels occur in women undergoing assisted reproductive technology (ART) owing to ovarian stimulation. Here, we investigated the association between maternal serum estradiol levels and the intellectual development of offspring conceived with ART.

Methods

A total of 204 singletons born after fresh embryo transfer were recruited for this cohort study. Among them, 102 children were born from mothers with high serum estradiol levels (> 12,000 pmol/L) on the day that human chorionic gonadotropin was administered. Another 102 children, matched by gestational age and age of the children, were recruited as controls from mothers with low serum estradiol (≤ 12,000 pmol/L). The Wechsler Preschool and Primary Scale of Intelligence was used to evaluate the intellectual development of the children.

Results

Children from mothers with higher serum estradiol levels scored lower in the verbal intelligence quotient (IQ) tests and verbal comprehension than children whose mothers had lower estradiol levels. The main difference between the two groups was in verbal subtests including information, vocabulary, and sorting. Partial correlation analysis revealed that the logarithm of maternal serum estradiol level negatively correlated with verbal IQ, performance IQ, and full scale IQ.

Conclusion

Our data demonstrate that a high maternal serum estradiol level may negatively associate the verbal ability of children conceived via ART.

Long-term health of children conceived after assisted reproductive technology

The aim of this narrative review is to summarize the present knowledge on long-term outcome of children born after assisted reproductive technologies (ART). The main outcomes covered are neurodevelopment including cerebral palsy, cognitive development, attention deficit hyperactivity disorder and autism spectrum disease, growth, cardiovascular function, diabetes type 1, asthma, malignancies, and reproductive health. Results have mainly been obtained from systematic reviews/meta-analyses and large registry studies. It has been shown that children born after ART, when restricted to singletons, have a similar outcome for many health conditions as their spontaneously conceived peers. For some outcomes, particularly cardiovascular function and diabetes, studies show some higher risk for ART singletons or subgroup of ART singletons. The fast introduction of new ART techniques emphasizes the importance of continuous surveillance of children born after ART.

School performance and long-term outcomes of very preterm children conceived via in vitro fertilization

Objective

To assess the impact of in vitro fertilization (IVF) on school performance and long-term outcomes in very preterm children aged 8-16 years.

Methods

Seventy-nine children born after IVF were compared with 79 randomly selected matched controls born after spontaneous conception (SC). Information was obtained from parents via a questionnaire administered through telephone interviews looking into school performance, including preschool education, repeated grades, extra lessons, special education needs, and learning difficulties; long-term status, including incidence of attention deficit hyperactivity disorder and autism; and family profile. Gross motor function was assessed against the gross motor function classification system based on information given by the subjects' families.

Results

Mothers of IVF children were more likely to have a high educational level than mothers of SC children. Moreover, a greater proportion of IVF children had received preschool education than SC children. After adjusting for potential confounders, there was no difference in the school performance or long-term outcomes between IVF and SC children.

Conclusion

In our study, the school performance and long-term outcomes of very preterm children born after IVF and of their spontaneously conceived peers were comparable. This information can help provide guidance to families and educators.

Intracytoplasmic sperm injection for male infertility and consequences for offspring

Intracytoplasmic sperm injection (ICSI) has become the most commonly used method of fertilization in assisted reproductive technology. The primary reasons for its popularity stem from its effectiveness, the standardization of the procedure, which means that it can easily be incorporated into the routine practice of fertility centres worldwide, and the fact that it can be used to treat virtually all forms of infertility. ICSI is the clear method of choice for overcoming untreatable severe male factor infertility, but its (over)use in other male and non-male factor infertility scenarios is not evidence-based. Despite all efforts to increase ICSI efficacy and safety through the application of advanced sperm retrieval and cryopreservation techniques, as well as methods for selecting sperm with better chromatin integrity, the overall pregnancy rates from infertile men remain suboptimal. Treating the underlying male infertility factor before ICSI seems to be a promising way to improve ICSI outcomes, but data remain limited. Information regarding the health of ICSI offspring has accumulated over the past 25 years, and there are reasons for concern as risks of congenital malformations, epigenetic disorders, chromosomal abnormalities, subfertility, cancer, delayed psychological and neurological development, and impaired cardiometabolic profile have been observed to be greater in infants born as a result of ICSI than in naturally conceived children. However, as subfertility probably influences the risk estimates, it remains to be determined to what extent the observed adverse outcomes are related to parental factors or associated with ICSI.

Epigenetics and Neurological Disorders in ART

About 1–4% of children are currently generated by Assisted Reproductive Technologies (ART) in developed countries. These babies show only a slightly increased risk of neonatal malformations. However, follow-up studies have suggested a higher susceptibility to multifactorial, adult onset disorders like obesity, diabetes and cardiovascular diseases in ART offspring. It has been suggested that these conditions could be the consequence of epigenetic, alterations, due to artificial manipulations of gametes and embryos potentially able to alter epigenetic stability during zygote reprogramming. In the last years, epigenetic alterations have been invoked as a possible cause of increased risk of neurological disorders, but at present the link between epigenetic modifications and long-term effects in terms of neurological diseases in ART children remains unclear, due to the short follow up limiting retrospective studies. In this review, we summarize the current knowledge about neurological disorders promoted by epigenetics alterations in ART. Based on data currently available, it is possible to conclude that little, if any, evidence of an increased risk of neurological disorders in ART conceived children is provided. Most important, the large majority of reports appears to be limited to epidemiological studies, not providing any experimental evidence about epigenetic modifications responsible for an increased risk.

Parental time to pregnancy, medically assisted reproduction and pubertal development in boys and girls

STUDY QUESTION

Does parental fertility, measured by time to pregnancy (TTP), or use of medically assisted reproduction (MAR) affect pubertal development in the offspring?

SUMMARY ANSWER

Neither TTP nor type of MAR treatment had clinically relevant implications for mean age at achieving individual pubertal milestones or overall timing of puberty in boys and girls.

WHAT IS KNOWN ALREADY

Parental TTP and MAR have been associated with impaired semen quality in adult sons. Timing of puberty reflects earlier signals of reproductive health, but it remains unclear whether parental fertility or MAR affects pubertal development, especially in the growing generation of children conceived by IVF or ICSI.

STUDY DESIGN, SIZE, DURATION

In this study, 15 819 children born by mothers in the Danish National Birth Cohort from 2000 to 2003 participated in a nationwide puberty cohort (participation rate = 70%). Parental TTP and use of MAR were reported by mothers in early pregnancy and children’s pubertal development data was self-recorded in web-based questionnaires from 11 years of age and 6 monthly throughout puberty (2012–2018).

PARTICIPANTS/MATERIALS, SETTING, METHODS

Pubertal development in children (of planned pregnancies, n = 13 285) born by untreated subfecund (TTP: 6–12 months) (n =2038), untreated severely subfeund (TTP: >12 months) (n = 1242), treated subfecund (n = 230) and treated severely subfecund (n = 1234) parents were compared to children born to more fertile parents (TTP: ≤5 months). We estimated mean monthly differences in mean age at achieving individual pubertal milestones (i.e. age at menarche, voice break, first ejaculation and Tanner stages 2, 3, 4 and 5 for breast or genital development and pubic hair growth) and a combined indicator of timing of puberty. Further, we compared mean age at achieving the individual pubertal milestones in children born by use of IVF or ICSI (n = 480) with children born by controlled ovarian stimulation or ovulation induction with or without intrauterine insemination (n = 902).

MAIN RESULTS AND THE ROLE OF CHANCE

We found tendencies towards slightly later mean age at male pubertal timing and slightly earlier mean age at female pubertal timing among children born by untreated subfecund, treated subfecund, untreated severely subfecund and treated severely subfecund parents. There were no specific patterns with increasing TTP, use of MAR nor type of MAR treatment, and the magnitude of the mean differences for individual milestones and overall timing of puberty were small, i.e. 0.9 months (95% CI: −1.0; 2.8) for first ejaculation and −0.5 months (95% CI: −2.0; 1.0) months for age at menarche in boys and girls, respectively, born by treated severely subfecund parents when compared with children born by more fertile parents.

LIMITATIONS, REASONS FOR CAUTION

Non-differential misclassification of the self-reported information on parental TTP and pubertal development in the offspring may serve as an alternative explanation of the findings, possibly biasing the estimates towards the null. The information on pubertal development was collected from around 11 years of age and onwards.

WIDER IMPLICATIONS OF THE FINDINGS

This study adds to the growing body of literature suggesting only limited harmful effects of parental subfecundity and MAR on offspring’s long-term growth and development.

STUDY FUNDING/COMPETING INTEREST(S)

This work was supported by the Danish Council for Independent Research [DFF 4183-00152]; and the Faculty of Health at Aarhus University. The authors have no financial relationships or competing interests to disclose.

Developmental outcome in a group of twins: Relation to perinatal factors and general movements

BACKGROUND

The quality of general movements (GMs) has proven to have predictive value for the developmental outcome, but this has not yet been studied in twins.

AIMS

Our aim was to analyse the quality of GMs and neurological and developmental outcome in relation to the gestational age (GA), mode of conception and other perinatal risk factors in a group of twins.

STUDY DESIGN

The documentation of twins referred for follow-up in the period from 1998 to 2016 was studied retrospectively. Data concerning the quality of GMs, perinatal risk factors and developmental outcome were analysed.

SUBJECTS

Eighty-nine twin pairs, GA from 24 to 38 weeks (median 35.0; IQR 3), birth weight 670 g-3820 g (median 2323; IQR 645) were included.

OUTCOME MEASURES

Results of neurological, psychological and speech/language development and school outcome were analysed.

RESULTS

GMs at term age and at three to four months postterm age did not differ with regard to the mode of conception. Preterm birth was significantly related to GMs at three to four months postterm age. At term age, GMs were significantly related to neurological outcome, while at three to four months postterm age, GMs were related to both the neurological and psychological outcome. Difficulties in speech/language development were diagnosed in almost half of the children, more frequently in boys and children with lower Apgar scores.

CONCLUSION

The study highlights the value of GMs for predicting the developmental outcome in twins and indicates the importance of developmental, especially speech/language, follow-up in twins.

The impact of specific fertility treatments on cognitive development in childhood and adolescence: a systematic review

STUDY QUESTION

Does fertility treatment influence cognitive ability in school aged children, and does the impact vary with the type of treatment?

SUMMARY ANSWER

The available high-quality evidence indicates that specific treatments may give rise to different effects on cognitive development, with certain treatments, including ICSI, associated with cognitive impairment.

WHAT IS KNOWN ALREADY

Previous reviews of the literature concerning cognitive outcomes among children conceived with medical assistance have concluded that study findings are generally 'reassuring', but limited attention has been paid to the quality of this research. In addition, no review has separately assessed the range of treatment modalities available, which vary in invasiveness, and thus, potentially, in their effects on developmental outcomes.

STUDY DESIGN, SIZE, DURATION

A systematic review was undertaken. We searched PubMed, PsycINFO and the Educational Resources Information Centre database to identify English-language studies published up until 21 November 2016.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Two authors independently reviewed identified articles, extracted data and assessed study quality. Studies were eligible if they assessed cognitive development from age 4 years or more, among children conceived with fertility treatment compared with either children conceived naturally or children born from a different type of fertility treatment. Where available, data were extracted and reported separately according to the various components of treatment (e.g. mode of fertilization, embryo freezing, etc.). Risk of bias was assessed using the Newcastle-Ottawa Scale, with a score ≥7/9 indicative of high quality.

MAIN RESULTS AND THE ROLE OF CHANCE

The search identified 861 articles, of which 35 were included. Of these, seven were rated high quality. Most studies (n = 22) were subject to selection bias, due to the exclusion of children at increased risk of cognitive impairment. Among high-quality studies, there was no difference in cognitive outcomes among children conceived with conventional IVF and those conceived naturally. Findings among high-quality studies of children conceived with ICSI were inconsistent: when compared with children conceived naturally, one study reported lower intelligence quotient (IQ; 5-7 points, on average) among ICSI children whereas the remaining two high-quality studies reported no difference between groups. Furthermore, among the three high-quality studies comparing children conceived with ICSI compared with conventional IVF, one reported a significant increase in the risk of mental retardation, one reported a small difference in IQ (3 points lower, on average) and one no difference at all. There were scant studies examining exposure to embryo freezing, or less invasive treatments such as ovulation induction without IVF/ICSI.

LIMITATION, REASONS FOR CAUTION

Most existing studies had methodological limitations including selection bias and/or failure to address confounding by family background. In addition, a meta-analysis could not be performed due to heterogeneity in the assessment of cognitive outcomes. These factors impeded our ability to synthesize the evidence and draw reliable conclusions.

WIDER IMPLICATIONS OF THE FINDINGS

The conflicting findings among studies of children conceived with ICSI require clarification, in light of the increasing use of this technique for reasons other than male-factor infertility. Further population-based studies are needed that utilize contemporary data to examine specific aspects of treatment and combinations of techniques (e.g. ICSI with frozen embryo cycles). Importantly, studies should include the complete group of children exposed to treatment.

STUDY FUNDING/COMPETING INTEREST(S)

A.R.R. is supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia. L.J.M. is funded by a fellowship from the Heart Foundation of Australia. The authors declare there are no competing interests.

TRIAL REGISTRATION NUMBER

Not applicable.

The safety of intracytoplasmic sperm injection and long-term outcomes

The pioneering of intracytoplasmic sperm injection (ICSI) approximately 25 years ago revolutionized the treatment of infertile couples. Today, ICSI remains an indispensable part of assisted reproductive treatments (ART) and has resulted in the birth of millions of babies. The 25th anniversary of ICSI marks a chronologic landmark in its evolving history. This landmark also serves as an opportunity to thoroughly appraise the safety of ICSI and analyze the long-term outcomes of ICSI-conceived children. In this review, we collate and analyze salient data accrued over the past 25 years pertaining to the long-term safety of ICSI and ICSI conceptions. We also evaluate the effects of ICSI on the perinatal outcomes, congenital malformation rates, cognitive development and reproductive health of ICSI-conceived neonates, children, adolescents and adults, respectively. In doing so, we also highlight the existence of potential confounders and biases that frequently obscure the interpretation of clinical follow-up studies.

Neurodevelopmental Outcomes After Assisted Reproductive Technologies

OBJECTIVE

To compare children's cognitive, motor, and language development at 2 years of age after assisted reproductive technologies (ARTs) relative to natural conception.

METHODS

The 3D-Study (2010-2012) is a prospective cohort study, which sought to improve the understanding among perinatal events, obstetric outcomes, and child development. A total of 2,366 pregnant women were recruited, of whom 278 conceived with ART: ovarian stimulation, intrauterine sperm insemination, in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation. Natural conception was defined as the unassisted establishment of pregnancy. Cognitive, motor, and language neurodevelopmental outcomes were compared between ART and natural conception groups at 24 months using the Bayley Scales of Infant and Toddler Development, 3rd edition, and the MacArthur-Bates Communicative Development Inventories. Adjusted linear regression models evaluated the effect of ART on neurodevelopmental outcomes using natural conception as a reference.

RESULTS

A total of 175 children in the ART group (62.9%) and 1,345 children in the natural conception group (64.4%) underwent neurodevelopmental assessment at 24 months postpartum. After adjusting for relevant confounders, children born after ART showed no difference in Bayley scales' cognitive scores (B1 [standard error]=-1.60 [0.9], 95% confidence interval [CI] -3.36 to 0.16), composite motor scores (B1 [standard error]=-1.33 [1.0], 95% CI -3.29 to 0.63), or MacArthur-Bates language scores (B1 [standard error]=-0.28 [2.1], 95% CI -4.39 to 3.83). No difference was observed when independent ART techniques were compared nor when comparing in vivo (ovarian stimulation or intrauterine insemination) or in vitro (in vitro fertilization, intracytoplasmic sperm injection, or in vitro maturation) techniques (P>.05).

CONCLUSION

Children born after ART had similar cognitive, motor, and language development as children born after natural conception at 2 years of age. These findings may be useful in the clinical counseling of patients undergoing ART.

Reduced Intellectual Ability in Offspring of Ovarian Hyperstimulation Syndrome: A Cohort Study

Background

Ovarian hyperstimulation syndrome (OHSS), a complication of ovarian stimulation, has various adverse effects on both pregnant women and their offspring. However, whether OHSS will affect intellectual ability in offspring is still unknown.

Methods

We recruited 86 Chinese children born to OHSS women and 172 children conceived with non-OHSS In Vitro Fertilization (IVF) in this cohort study. Their intellectual ability was assessed according to the Revised Chinese Version of the Wechsler Intelligence Scale for Children (C-WISC). Verbal Intelligence Quotient (VIQ), Performance Intelligence Quotient (PIQ), and Full Intelligence Quotient (FIQ) were calculated. The investigation was registered in Chinese Clinical Trial Registry (ChiCTR-SOC-16009555).

Findings

OHSS offspring scored less on C-WISC (mean (standard deviation [SD]): (VIQ = 92.7 (14.7), PIQ = 108.9 (13.1), FIQ = 100.6 (13.4)) compared with non-OHSS IVF offspring (VIQ = 100.1 (13.2), PIQ = 113.7 (10.8), FIQ = 107.4 (11.5)). The prevalence of low IQ (< 80) children was 4.7 times higher in OHSS offspring compared with non-OHSS offspring. Maternal estradiol level on hCG administration day was negatively associated with FIQ in offspring.

Interpretation

OHSS offspring displayed reduced intellectual ability. Prenatal estradiol exposure might be involved in underlying mechanism.

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Young children born to OHSS women displayed the lower IQ than non-OHSS IVF children.

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Maternal serum estradiol level on hCG administration day was negatively correlated with IQ of offspring.

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The prevalence of low IQ(<80) children was 4.7 times higher in OHSS offspring.

Ovarian hyperstimulation syndrome (OHSS) is a complication of assisted reproductive technologies. We discovered that children of OHSS mothers displayed reduced intelligence quotient (IQ). This reduction might be associated with higher estradiol level during early pregnancy. Clinician should use ovarian stimulation therapy wisely to avoid OHSS.

Psychosocial needs of women and their partners after successful assisted reproduction treatment in Barcelona

It is assumed that pregnancy and parenthood after a period of infertility are unproblematic and gratifying. However, a review of the literature highlights the complexity of the psychological and social consequences of pregnancy, childbirth and parenting after successful treatment with assisted reproductive technology. These experiences, including those following the creation of new forms of non-genetic and/or social parenthood, require investigation in order to understand how women and their partners integrate their journey from infertility to pregnancy and parenthood after successful assisted reproductive treatment. This paper presents results derived from qualitative interviews with 30 pregnant women and 21 couples after assisted reproductive treatment (repeated rounds of individual interviews with the study participants) conducted from July 2010 to April 2014 as part of a larger ethnographic study exploring the psychosocial needs of women and partners following assisted reproductive treatment in Barcelona's. The transcribed text was coded into categories of either predetermined or emergent topics. Prior studies have found that couples who achieve pregnancy after infertility may experience higher levels of anxiety in relation to pregnancy. This anxiety can be linked with a higher risk of complications during pregnancy after assisted reproductive treatment compared with spontaneous conception. However, the evidence concerning adjustment to pregnancy and parenthood is inconclusive. This study highlights the necessity for participants to give meaning to these treatments, given the variability that exists in perceptions of infertility and pregnancy after successful assisted reproductive treatment.

Parental Infertility, Fertility Treatment, and Childhood Epilepsy: A Population-Based Cohort Study

BACKGROUND

A few studies have indicated an increased risk of epilepsy in children conceived by fertility treatment possibly due to characteristics of the infertile couple rather than the treatment. We therefore aimed to investigate the association between parental infertility, fertility treatment, and epilepsy in the offspring, including the subtypes of epilepsy; idiopathic generalised epilepsy and focal epilepsy.

METHODS

This cohort included all pregnancies resulting in liveborn singletons from the Aarhus Birth Cohort, Denmark (1995-2013). Information on time to pregnancy and fertility treatment was obtained from pregnancy questionnaires in early pregnancy. Children developing epilepsy were identified from the Danish National Patient Register and the Danish National Prescription Registry until 2013. Data were analysed using Cox proportional hazards regression adjusted for potential confounders.

RESULTS

A total of 60 440 pregnancies were included, and 0.8% of the children developed epilepsy.The primary analyses showed no association between parental infertility or fertility treatment, and the overall risk of childhood epilepsy (hazard rate ratios (HRs); 95% confidence intervals (CIs): 1.08 (0.73, 1.60) and 1.04 (0.71, 1.52)). In secondary analyses, both parental infertility and fertility treatment were associated with an increased risk of idiopathic generalised epilepsy (HRs and 95% CIs: 2.25 (1.10, 4.58) and 2.45 (1.26, 4.75)). No association was seen for focal epilepsy.

CONCLUSION

Parental infertility or fertility treatment was not associated with an overall risk of childhood epilepsy. Parental infertility may be associated with an increased risk of idiopathic generalised epilepsy; a subtype of epilepsy believed to be of genetic origin.

Time to take human embryo culture seriously

STUDY QUESTION

Is it important that end-users know the composition of human embryo culture media?

SUMMARY ANSWER

We argue that there is as strong case for full transparency concerning the composition of embryo culture media intended for human use.

WHAT IS KNOWN ALREADY

Published data suggest that the composition of embryo culture media may influence the phenotype of the offspring.

STUDY DESIGN, SIZE, DURATION

A review of the literature was carried out.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Data concerning the potential effects on embryo development of culture media were assessed and recommendations for users made.

MAIN RESULTS AND THE ROLE OF CHANCE

The safety of ART procedures, especially with respect to the health of the offspring, is of major importance. There are reports from the literature indicating a possible effect of culture conditions, including culture media, on embryo and fetal development. Since the introduction of commercially available culture media, there has been a rapid development of different formulations, often not fully documented, disclosed or justified. There is now evidence that the environment the early embryo is exposed to can cause reprogramming of embryonic growth leading to alterations in fetal growth trajectory, birthweight, childhood growth and long-term disease including Type II diabetes and cardiovascular problems. The mechanism for this is likely to be epigenetic changes during the preimplantation period of development. In the present paper the ESHRE working group on culture media summarizes the present knowledge of potential effects on embryo development related to culture media, and makes recommendations.

LIMITATIONS, REASONS FOR CAUTION

There is still a need for large prospective randomized trials to further elucidate the link between the composition of embryo culture media used and the phenotype of the offspring. We do not presently know if the phenotypic changes induced by in vitro embryo culture represent a problem for long-term health of the offspring.

WIDER IMPLICATIONS OF THE FINDINGS

Published data indicate that there is a strong case for demanding full transparency concerning the compositions of and the scientific rationale behind the composition of embryo culture media.

STUDY FUNDING/COMPETING INTERESTS

This work was funded by The European Society for Human Reproduction and Embryology. No competing interests to declare.

Long-awaited pregnancy: intelligence and academic performance in offspring of infertile parents-a cohort study

OBJECTIVE

To study whether fertility treatment, subfertility, or pregnancy planning are related to long-term intellectual development.

DESIGN

Cohort study.

SETTING

Not applicable.

PATIENT(S)

A total of 5,032 singletons born from 1990 to 1992 in the Aarhus Birth Cohort were followed up to a mean age of 19 years. These children were born as a result of fertility treatment (n = 210), had subfertile parents who took more than 12 months before conceiving naturally (n = 334), had fertile parents who conceived naturally within 12 months (n = 2,661), or had parents who reported the pregnancy as unplanned (n = 1,827).

INTERVENTION(S)

The children were followed up using questionnaires and information from Danish national registers.

MAIN OUTCOME MEASURE(S)

Parent reported school difficulties at ages 9-11 years, register-based school grades at ages 16, 17, and 19 years, and conscription intelligence test scores at age 19 years.

RESULT(S)

We found no evidence of school difficulties in childhood, impaired school performance in adolescence, or lower intelligence in young adulthood in multivariate analyses adjusted for parental age, educational level, maternal parity, before pregnancy body mass index (BMI), smoking and alcohol intake in pregnancy, cohabitation status, child gender, and age.

CONCLUSION(S)

In the longest follow-up of cognitive development of children conceived after fertility treatment or by subfertile parents conducted so far, this study did not show any association between pregnancy planning, subfertility, or fertility treatment and cognitive ability or academic performance.

Evidence-Based Care for Couples With Infertility

When couples cannot achieve pregnancy, they often seek health care from medical and nursing specialists. The care the couple receives begins with a thorough assessment to determine the possible cause of infertility and to plan appropriate care to ensure the best chance for the couple to have a biological child. In this article, we provide an overview of the etiology and evaluation of infertility, the various treatment options available, and the appropriate clinical implications.