Cognitive development following ART: effect of choice of comparison group, confounding and mediating factors

Assisted reproductive technology and neurodevelopment in children at 1 year of age: a longitudinal birth cohort study

BACKGROUND

With remarkable advancements in assisted reproductive technology (ART), the number of ART-conceived children continues to increase. Despite increased research investigating the outcomes of ART children, evidence on neurodevelopment remains controversial.

OBJECTIVE

The aim of this study was to investigate the association between ART use and neurodevelopment in children at 1 year of age and to determine whether the characteristics of parental infertility and specific ART procedures affect neurodevelopment in children.

STUDY DESIGN

The Jiangsu Birth Cohort enrolled couples who received ART treatment and who conceived spontaneously (2014-2020) in Jiangsu Province, China. In this study, we included 3531 pregnancies with 3840 cohort children who completed neurodevelopment assessment at 1 year of age, including 1906 infants conceived by ART (including 621 twins). Poisson regressions were fitted to estimate unadjusted and adjusted risk ratios (RRs) and 95% confidence intervals (CIs) for ART use with neurodevelopmental outcomes (cognition, receptive communication, expressive communication, fine motor, and gross motor) in children.

RESULTS

Among singletons, ART use was associated with a 24% to 34% decrease in the risk for noncompetent development in 3 domains (cognition, adjusted RR, 0.66; 95% CI, 0.53-0.82; receptive communication, 0.76; 0.64-0.91; expressive communication, 0.69; 0.51-0.93) after adjustment for conventional covariates. However, an inverse association was observed in the gross motor domain, with ART singletons having a greater risk of being noncompetent in gross motor development than their non-ART counterparts (adjusted RR, 1.41; 95% CI, 1.11-1.79). Compared with singletons, twins resulting from ART treatment demonstrated compromised neurodevelopment in several domains. Furthermore, we continued to observe that the transfer of 'poor' quality embryos was associated with greater risks for noncompetent development in receptive communication (adjusted RR, 1.50; 95% CI, 1.05-2.14) and gross motor domains (1.55; 1.02-2.36) among ART singletons.

CONCLUSION

These results generally provide reassuring evidence among singletons born after ART in the cognition, communication, and fine motor domains, but drawn attention to their gross motor development. The quality of transferred embryos in ART treatment might be associated with offspring neurodevelopment; however, the potential associations warrant further validation in independent studies, and the clinical significance needs careful interpretation.

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.

The association between conception history and subsequent postpartum depression and/or anxiety: Evidence from the Clinical Practice Research Datalink 1991-2013

BACKGROUND

Infertility, and fertility treatment, are associated with psychological distress that may influence subsequent mental health including postpartum depression and anxiety.

METHODS

Data for women who had a livebirth between 1991 and 2013 were drawn from the Clinical Practice Research Datalink. Conception history prior to their first recorded birth was categorised as 'no fertility problems', 'untreated subfertility', ovulation induction (OI), and assisted reproductive technologies (ART). Depression and/or anxiety in the 12 months postpartum were identified using records of diagnoses, symptoms, and prescriptions. Prevalence was compared, and odds ratios estimated using multivariable logistic regression.

RESULTS

Of 235,127 mothers, 31,947 (13.6%) had evidence of postpartum depression and/or anxiety. Mothers in the ART group had 22% lower odds of postnatal depression and/or anxiety compared to mothers in the fertile group (OR 0.78; 95% CI [0.70-0.86]; p < 0.0001). Accounting for prior mental health, lifestyle, sociodemographic and pregnancy-related factors reduced the strength of the association (aOR 0.87; 95% CI [0.78-0.97]; p = 0.01). There were no significant associations observed in the untreated subfertility or OI groups.

LIMITATIONS

As in any analysis of routine data, the quality of recording is important and some information was unavailable (e.g. education, social support).

CONCLUSIONS

Women with a history of subfertility, OI or ART treatment were not at increased risk of postpartum depression and/or anxiety compared to those with no fertility problems. It is important to explore whether women who underwent ART are less likely to experience depression/anxiety or do not seek help when needed, with implications for their health and care.

The Consequences of Assisted Reproduction Technologies on the Offspring Health Throughout Life: A Placental Contribution

The use of assisted reproductive technologies (ART) worldwide has led to the conception and birth of over eight million babies since being implemented in 1978. ART use is currently on the rise, given growing infertility and the increase in conception age among men and women in industrialized countries. Though obstetric and perinatal outcomes have improved over the years, pregnancies achieved by ART still bear increased risks for the mother and the unborn child. Moreover, given that the first generation of ART offspring is now only reaching their forties, the long-term effects of ART are currently unknown. This is important, as there is a wealth of data showing that life-long health can be predetermined by poor conditions during intrauterine development, including irregularities in the structure and functioning of the placenta. In the current review, we aim to summarize the latest available findings examining the effects of ART on the cardiometabolic, cognitive/neurodevelopmental, and behavioral outcomes in the perinatal period, childhood and adolescence/adulthood; and to examine placental intrinsic factors that may contribute to the developmental outcomes of ART offspring. Altogether, the latest knowledge about life outcomes beyond adolescence for those conceived by ART appears to suggest a better long-term outcome than previously predicted. There are also changes in placenta structure and functional capacity with ART. However, more work in this area is critically required, since the potential consequences of ART may still emerge as the offspring gets older. In addition, knowledge of the placenta may help to foresee and mitigate any adverse outcomes in the offspring.

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.

Fathers of children conceived using ART have higher cognitive ability scores than fathers of naturally conceived children

STUDY QUESTION

Does paternal cognitive ability differ for children conceived with and without assisted reproductive technology (ART)?

SUMMARY ANSWER

Young fathers of ART conceived children tend to score cognitively below their same-age natural conception (NC) counterparts and older (above 35) fathers of ART conceived children tend to score above.

WHAT IS KNOWN ALREADY

Cognitive ability is a genetically and socially transmitted trait, and If ART and NC children have parents with different levels of this trait, then this would in itself predict systematic differences in child cognitive outcomes. Research comparing cognitive outcomes of children with different modes of conception finds conflicting results, and studies may be influenced by selection and confounding.

STUDY DESIGN, SIZE, DURATION

This is a population-based study based on Norwegian data, combining information from the Medical Birth Registry (births through 2012), military conscription tests (birth cohorts 1955–1977) and the population registry. These data allow us to compare the cognitive ability scores of men registered as the father of an ART-conceived child to the cognitive abilities of other fathers and to average scores in the paternal birth cohorts.

PARTICIPANTS/MATERIALS, SETTINGS, METHODS

The population level study included 18 566 births after ART (5810 after ICSI, 12 756 after IVF), and 1 048 138 NC births. It included all Norwegian men who received a cognitive ability score after attending military conscription between 1973 and 1995. This constituted 614 827 men (89.4% of the male birth cohorts involved). An additional 77 650 unscored males were included in sensitivity analyses.

MAIN RESULTS AND THE ROLE OF CHANCE

Paternal cognitive level was assessed using intelligence quotients (IQ) converted from stanine scores on a three-part cognitive ability test with items measuring numeracy, vocabulary and abstract thought (Raven-like matrices). ART fathers averaged 1.95 IQ points above the average of their own birth cohort (P-value &lt; 0.0005) and 1.83 IQ points above NC fathers in their own birth cohort (P &lt; 0.0005). Comparisons of the IQ of ART fathers to those of NC fathers of similar age and whose children were born in the same year, however, found average scores to be more similar (point estimate 0.24, P = 0.023). These low average differences were found to differ substantially by age of fatherhood, with young ART fathers scoring below their NC counterparts and older ART fathers scoring above their NC counterparts.

LIMITATIONS, REASONS FOR CAUTION

We do not have information on maternal cognition. We also lack information on unsuccessful infertility treatments that did not result in a live birth.

WIDER IMPLICATIONS OF THE FINDINGS

Paternal cognitive ability of ART children differs from that of NC children, and this difference varies systematically with paternal age at child birth. Selection effects into ART may help explain differences between ART and NC children and need to be adequately controlled for when assessing causal effects of ART treatment on child outcomes.

STUDY FUNDING/COMPETING INTEREST(S)

This research has also been supported by the Research Council of Norway through its Centres of Excellence funding scheme, project number 262700 (Centre for Fertility and Health). It has also been supported by the Research Council of Norway’s Project 236992 (Egalitarianism under pressure? New perspectives on inequality and social cohesion). There are no competing interests.

TRIAL REGISTRATION NUMBER

N/A

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.

Cognitive development in children up to age 11 years born after ART-a longitudinal cohort study

STUDY QUESTION

How does the cognitive development of children conceived after ART (IVF and ICSI) - measured as cognitive skills at age 3, 5, 7 and 11 years - differ over time from those born after natural conception (NC)?

SUMMARY ANSWER

Improved measures of cognitive development up to age 5 years were recorded in children conceived with ART compared to NC, which attenuates by 11 years, with ART children still scoring slightly better than NC children.

WHAT IS KNOWN ALREADY

Results on the cognitive outcomes of children conceived after ART have been highly contradictory. Some have shown that ART children have an impaired behavioural, socio-emotional and cognitive development and higher risk of mental disorders. Others have reported no increased risk or difference. Cognitive development has not been previously examined using latent growth curve models from ages 3 to 11 years, also including appropriate attention to confounding parental characteristics.

STUDY DESIGN, SIZE, DURATION

Longitudinal data for the first five waves (2000-2012) of the UK Millennium Cohort Study were used, which is a two-stage sample of all infants born in 2000-2001 and resident in the UK at 9 months of age, drawn from the Department of Social Security Child Benefit Registers. A final sample of N = 15 218 children (125 IVF and 61 ICSI), from 14 816 families was used. Information was available for all waves for 8298 children. Four additional follow-up surveys were conducted in 2003, 2005, 2007 and 2012.

PARTICIPANTS/MATERIALS, SETTING, METHODS

Our sample includes children born within a union (married or cohabiting parents) and where information on cognitive scores was available for at least two measurement points. Cognitive development was assessed with the British Ability Scales. At age 3 and 5 years (wave 2 and 3), children completed the naming vocabulary component, which measures expressive verbal ability. At age 7 years (wave 4), verbal cognitive abilities were assessed through the word reading test, and at age 11 years (wave 5) through a verbal similarity test. Two-tailed Student's t-tests examined differences between ART and NC groups. Growth curve models (random-coefficient, latent trajectory models) were used to study the effect of ART, confounding parental characteristics and health outcomes at birth, both at a baseline level of cognitive ability at age 3 years and on its growth rate.

MAIN RESULTS AND THE ROLE OF CHANCE

At age 3 and 5 years, children conceived with the aid of ART have higher verbal cognitive abilities than NC children (P < 0.001) but this consistently decreases over time and diminishes by age 11 years. Parental environment and resources are pivotal in children's cognitive development.

LIMITATIONS, REASON FOR CAUTION

The sample size of the ART cohort of children is small across each time period (N = 150-180) in comparison with NC children (N = 10 496-11 955). Owing to a limited sample size, we are also unable to compare IVF versus ICSI treatment.

WIDER IMPLICATIONS OF THE FINDINGS

With the increasing use of IVF and ICSI, these results indicate that there are no detrimental effects on children's early cognitive outcomes up to age 11 years, and highlight the importance of parental characteristics.

STUDY FUNDING/COMPETING INTEREST(S)

Funding for this project was provided by the European Union's Seventh Framework Program (FP7 2007-2013) (No. 320116 Families and Societies), ESRC/NCRM SOCGEN Grant (ES/N0011856/1) and the SOCIOGENOME ERC Consolidator Grant (ERC-2013-CoG-615603) (to M.C.M.). The authors have no competing interests to declare.

TRIAL REGISTRATION NUMBER

N/A.

Neurological condition assessed with the Hempel examination and cognition and behaviour at 4years

AIM

To investigate associations between neurological condition, assessed with the Hempel examination, in terms of minor neurological dysfunction (MND) and neurological optimality, and cognition and behaviour at 4years.

STUDY DESIGN

Cross-sectional analyses within a prospective, assessor-blinded follow-up study.

SUBJECTS

Four-year-old singletons born to subfertile parents (n=235; 120 boys).

OUTCOME MEASURES

Outcome parameters were complex minor neurological dysfunction (complex MND) and the neurological optimality score (NOS). Cognitive outcome was evaluated with the Kaufman Assessment Battery for Children, resulting in a total intelligence quotient (IQ). Behavioural outcome was evaluated with the Child Behavior Checklist, resulting in a total problem T-score.

RESULTS

Fifty-seven (24.3%) children had complex MND. None of the children showed fine motor dysfunction, suggesting a ceiling effect of the Hempel assessment. Complex MND was not correlated with IQ or total problem T-score. Nevertheless, a higher NOS was correlated with a higher IQ and a lower total problem T-score (adjusted mean estimate [95% confidence interval]: cognition: 0.445 [0.026; 0.865], p=0.038; behaviour: -0.458 [-0.830; -0.087], p=0.016).

INTERPRETATION

At age 4, complex MND assessed with the Hempel assessment was not associated with cognition and behaviour, presumably due to a ceiling effect in the Hempel domain of fine motor function. A more optimal neurological condition was associated with higher IQ and better behaviour.

The health outcomes of human offspring conceived by assisted reproductive technologies (ART)

Concerns have been raised about the health and development of children conceived by assisted reproductive technologies (ART) since 1978. Controversially, ART has been linked with adverse obstetric and perinatal outcomes, an increased risk of birth defects, cancers, and growth and development disorders. Emerging evidence suggests that ART treatment may also predispose individuals to an increased risk of chronic ageing related diseases such as obesity, type 2 diabetes and cardiovascular disease. This review will summarize the available evidence on the short-term and long-term health outcomes of ART singletons, as multiple pregnancies after multiple embryos transfer, are associated with low birth weight and preterm delivery, which can separately increase risk of adverse postnatal outcomes, and impact long-term health. We will also examine the potential factors that may contribute to these health risks, and discuss underlying mechanisms, including epigenetic changes that may occur during the preimplantation period and reprogram development in utero, and adult health, later in life. Lastly, this review will consider the future directions with the view to optimize the long-term health of ART children.

Long-term follow-up of children conceived through assisted reproductive technology

Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced.

Assisted reproductive technologies and children's neurodevelopmental outcomes

Initial reports suggested that children conceived with assisted reproductive technologies (ART) may be at increased risk for a spectrum of developmental disabilities. Evolving evidence suggests that some of the early risks may have been overstated when not taking plurality of birth or gestational age at delivery into consideration, as both are independent risk factors for neurodevelopmental disabilities arising from alterations in structure and function or limitations in activities. Continued research is needed to overcome lingering data gaps in light of the equivocal literature for many neurodevelopmental disabilities relative to ART, increasing utilization of services, and changes in the clinical management of infecund couples such as the adoption of natural cycles or in vitro maturation treatment options. Population-based cohorts with longitudinal assessment of the multifaceted nature of neurodevelopment across critical and sensitive windows is paramount for the development of empirically based guidance for clinical and population health.

Health and development of ART conceived young adults: a study protocol for the follow-up of a cohort

BACKGROUND

Use of assisted reproductive technologies (ART) continues to increase, yet little is known of the longer term health of ART conceived offspring. There are some adverse birth outcomes associated with ART conception but the subsequent developmental trajectory is unclear. Undertaking research in this area is challenging due the sensitive nature of the topic and the time elapsed since birth of the ART conceived young adults. The aim of this report is to describe a research protocol, including design and ethical considerations, used to compare the physical and psychosocial health outcomes of ART conceived young adults aged 18-28 years, with their spontaneously conceived peers.

DESIGN

This is a retrospective cohort study of mothers who conceived with ART in Victoria, Australia and gave birth to a singleton child between 1982 and 1992. A current address for each mother was located and a letter of invitation to participate in the study was sent by registered mail. Participation involved completing a telephone interview about her young adult offspring's health and development from birth to the present. Mothers were also asked for consent for the researcher to contact their son/daughter to invite them to complete a structured telephone interview about their physical and psychosocial health. A comparison group of women living in Victoria, Australia, who had given birth to a spontaneously conceived singleton child between 1982 and 1992 was recruited from the general population using random digit dialling. Data were collected from them and their young adult offspring in the same way. Regression analyses were used to evaluate relationships between ART exposure and health status, including birth defects, chronic health conditions, hospital admissions, growth and sexual development. Psychosocial wellbeing, parental relationships and educational achievement were also assessed. Factors associated with the age of disclosure of ART conception were explored with the ART group only.

DISCUSSION

The conceptualization and development of this large project posed a number of methodological, logistical and ethical challenges which we were able to overcome. The lessons we learnt can assist others who are investigating the long-term health implications for ART conceived offspring.

Effects of pregnancy planning, fertility, and assisted reproductive treatment on child behavioral problems at 5 and 7 years: evidence from the Millennium Cohort Study

OBJECTIVE

To examine the effects of pregnancy planning, time to conception (TTC), and assisted reproductive technologies (ART) on child behavior.

DESIGN

Prospective cohort study.

SETTING

Not applicable.

PATIENT(S)

A total of 12,380 singletons recruited at 9 months and followed-up at 5 and 7 years. Conceptions were divided into "unplanned" (unplanned, unhappy), "mistimed" (unplanned, happy), "planned" (planned, TTC <12 months), "subfertile" (planned, TTC ≥ 12 months), "ovulation induced" (received clomiphene citrate), and "ART" (IVF or intracytoplasmic sperm injection).

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Child behavior (Strengths and Difficulties Questionnaire [SDQ]).

RESULT(S)

Mistimed and unplanned children had higher average SDQ scores at age 5 and 7 years and were significantly more likely to have a clinically relevant behavioral problem compared with the planned group. The ART children had significantly higher average SDQ scores at both 5 and 7 years compared with the planned group. An increase in clinically relevant behavioral problems was observed at 5 years (odds ratio 2.05 [95% confidence interval 0.96, 4.42]) but failed to reach statistical significance. No effects were observed in the subfertile and ovulation-induced groups.

CONCLUSION(S)

Unplanned and mistimed children exhibit more behavioral problems than their planned peers. Though ART children have higher mean total difficulties scores, this did not translate into a statistically significant increase in clinically relevant behavioral problems.

Morphologic abnormalities in 2-year-old children born after in vitro fertilization/intracytoplasmic sperm injection with preimplantation genetic screening: follow-up of a randomized controlled trial

OBJECTIVE

To evaluate the effect of preimplantation genetic screening (PGS) on morphologic outcome in children.

DESIGN

Follow-up of a randomized controlled trial (RCT).

SETTING

University hospital.

PATIENT(S)

Two-year-old children born to mothers who participated in an RCT on the efficacy of PGS: 50 children born after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) with PGS (intervention group; PGS+) and 72 children born after IVF/ICSI only (control group; PGS-). Sixty-six age-matched children conceived without any form of assisted reproduction were recruited separately in a local public health service center (reference group).

INTERVENTION(S)

PGS.

MAIN OUTCOME MEASURE(S)

Body surface examination and anthropometry. The evaluation of morphologic abnormalities allowed assessment of children's phenotype in detail. Morphologic abnormalities were classified as major abnormalities (abnormal development in organogenesis, deformations, disruptions, or dysplasia) and minor anomalies (deviations in phenogenesis).

RESULT(S)

The percentage of children with ≥ 1 major abnormality was 28% in the PGS+ and 35% in the PGS- group [difference -7%, 95% CI -23% to 10%]. The percentage of children with ≥ 1 minor anomaly was 64% in the PGS+ and 67% in the PGS- group [difference -3%, 95% CI -15% to 20%]. In the reference group 30% of the children had ≥ 1 major abnormality [95% CI 20% to 43%] and 74% had ≥ 1 minor anomaly [95% CI 62% to 84%].

CONCLUSION(S)

No statistically significant differences were found in minor anomalies between children conceived after IVF/ICSI with or without PGS. There is < 2.5% chance of ≥ 10% more major abnormalities in children born after PGS.