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Wang W, Meng Q, Hu L, Du J, Xu B, Han X, Liu X, Zhou K, Ke K, Gan M, Zhu X, Peng Y, Xue H, Xiao S, Lv H, Jiang Y, Jiang T, Ma H, Ling X, Hu Z, Lin Y. Assisted reproductive technology and neurodevelopment in children at 1 year of age: a longitudinal birth cohort study. Am J Obstet Gynecol 2024:S0002-9378(24)00625-2. [PMID: 38782229 DOI: 10.1016/j.ajog.2024.05.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- Weiting Wang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qingxia Meng
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Reproductive Genetic Center, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China
| | - Lingmin Hu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Reproduction, Changzhou Maternity and Child Health Care Hospital, Changzhou Medical Center, Nanjing Medical University, Changzhou, Jiangsu, China
| | - Jiangbo Du
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Bo Xu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiumei Han
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaoyu Liu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kun Zhou
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Kang Ke
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ming Gan
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xianxian Zhu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuting Peng
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Huixin Xue
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shuxin Xiao
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hong Lv
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yangqian Jiang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Tao Jiang
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Hongxia Ma
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiufeng Ling
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Reproduction, Women's Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing, Jiangsu, China.
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China; Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Yuan Lin
- State Key Laboratory of Reproductive Medicine and Offspring Health, Nanjing Medical University, Nanjing, Jiangsu, China; Department of Maternal, Child and Adolescent Health, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, Jiangsu, China; State Key Laboratory of Reproductive Medicine and Offspring Health (Suzhou Centre), The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, Jiangsu, China.
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Djuwantono T, Aviani JK, Permadi W, Halim D, Achmad TH, Dhamayanti M. Intelligence, motoric and psychological outcomes in children from different ART treatments: a systematic review and meta-analysis. J Neurodev Disord 2023; 15:26. [PMID: 37608302 PMCID: PMC10463915 DOI: 10.1186/s11689-023-09490-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/27/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Subtle abnormalities in children's intelligence, motor skills, and psychology from various assisted reproductive treatments (ARTs) might be underdiagnosed. Understanding the prognosis of intelligence, motor skills, and psychology in children from ART would provide parents with reasonable expectations and enable them to plan relevant support to achieve the optimum potential in ART children. METHODS We searched PubMed, EMBASE, Ovid, Google Scholar, and Scopus databases until April 13, 2021, to identify relevant studies. Thirty-four studies met the inclusion and exclusion criteria. The meta-analysis employed a standardized mean difference model. The outcome of this study is to compare intelligence quotient (IQ), motoric ability, and behavioral problems between all ARTs, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) to naturally conceived (NC) children. Subdomains of intelligence based on the Cattell, Horn, and Carroll Model (CHC Model) of cognitive architecture, including fluid reasoning, short-term and working memory, processing speed, visual-spatial ability, long-term memory retrieval, and crystalized intelligence (knowledge), were evaluated and summarized in details. Motor skill was stratified into two domains: gross motoric and fine motoric. Behavioral problem was categorized as externalizing and internalizing behavior. RESULTS Meta-analysis showed that verbal intelligence score in IVF toddlers is significantly lower than NC toddlers (p = 0.02); conversely, ICSI toddlers scored significantly higher verbal intelligence score compared to NC toddlers (p = 0.005). Toddlers born after ART had significantly lower non-verbal intelligence score (p = 0.047). IVF toddlers scored significantly lower fine motor score (p = 0.01) compared to naturally conceived toddlers. Based on parent's CBCL, NC toddlers had higher total (p = 0.01) and externalizing behavior (p = 0.001) scores compared to ART toddlers. Evaluation of full scale IQ and all domains of intelligence in preschool and primary school children revealed that no significant differences exist between ART and NC children. Based on preschool and primary school parents' CBCL, IVF children had significantly lower externalizing behavior score compared to NC children (p = 0.04). Meta-analyses of studies on young adolescents revealed that ART young adolescents scored higher academically than their NC counterparts, including on mathematics (p < 0.00001) and reading or language (p < 0.00001). CONCLUSIONS Despite differences in certain aspects, this finding suggests that ART is unlikely to cause negative impacts on children's neurodevelopment.
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Affiliation(s)
- Tono Djuwantono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
- Bandung Fertility Center, Limijati Mother and Child Hospital, Bandung, West Java, Indonesia.
| | - Jenifer Kiem Aviani
- Bandung Fertility Center, Limijati Mother and Child Hospital, Bandung, West Java, Indonesia
| | - Wiryawan Permadi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia
| | - Danny Halim
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Tri Hanggono Achmad
- Research Center for Medical Genetics, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
- Department of Basic Medical Science, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java, Indonesia
| | - Meita Dhamayanti
- Department of Child Health, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, West Java, Bandung, Indonesia.
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Li W, Zhao J, Ni M, Zhang Q, Shen Q, Li H, Tang Z, Yao D, Wang T, Qi S, Li B, Ding X, Xie J, Wang X, Wang B, Liu Z. Assisted reproductive technology and neurodevelopmental outcomes in offspring: a prospective birth cohort study in East China. Reprod Biomed Online 2023; 46:983-994. [PMID: 37068978 DOI: 10.1016/j.rbmo.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
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.
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Affiliation(s)
- Wei Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jiuru Zhao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Meng Ni
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Qianqian Zhang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Qianwen Shen
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hong Li
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Tang
- International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dongting Yao
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Tao Wang
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Sudong Qi
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Baihe Li
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Xiya Ding
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Jinliang Xie
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaojin Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingshun Wang
- Department of Biostatistics, Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhiwei Liu
- International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; International Peace Maternity and Child Health Hospital of China Welfare Institution, School of Medicine, Shanghai Jiao Tong University, Shanghai, China; Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
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Boutet ML, Eixarch E, Ahumada‐Droguett P, Nakaki A, Crovetto F, Cívico MS, Borrás A, Manau D, Gratacós E, Crispi F, Casals G. Fetal neurosonography and infant neurobehavior following conception by assisted reproductive technology with fresh or frozen embryo transfer. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:646-656. [PMID: 35468238 PMCID: PMC9828610 DOI: 10.1002/uog.24920] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 05/13/2023]
Abstract
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.
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Affiliation(s)
- M. L. Boutet
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - E. Eixarch
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centre for Biomedical Research on Rare Diseases (CIBER‐ER)MadridSpain
| | - P. Ahumada‐Droguett
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - A. Nakaki
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
| | - F. Crovetto
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centre for Biomedical Research on Rare Diseases (CIBER‐ER)MadridSpain
| | - M. S. Cívico
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Assisted Reproduction UnitHospital Clínic de Barcelona, Universitat de BarcelonaBarcelonaSpain
| | - A. Borrás
- Assisted Reproduction UnitHospital Clínic de Barcelona, Universitat de BarcelonaBarcelonaSpain
| | - D. Manau
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Assisted Reproduction UnitHospital Clínic de Barcelona, Universitat de BarcelonaBarcelonaSpain
| | - E. Gratacós
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centre for Biomedical Research on Rare Diseases (CIBER‐ER)MadridSpain
| | - F. Crispi
- BCNatal, Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Centre for Biomedical Research on Rare Diseases (CIBER‐ER)MadridSpain
| | - G. Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS)BarcelonaSpain
- Assisted Reproduction UnitHospital Clínic de Barcelona, Universitat de BarcelonaBarcelonaSpain
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Perros P, Psarris A, Antsaklis P, Theodora M, Syndos M, Koutras A, Ntounis T, Fasoulakis Z, Rodolakis A, Daskalakis G. Neurodevelopmental Outcomes of Pregnancies Resulting from Assisted Reproduction: A Review of the Literature. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101511. [PMID: 36291447 PMCID: PMC9600207 DOI: 10.3390/children9101511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/23/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
The term infertility is defined as the lack of conception within 1 year of unprotected intercourse. It affects more than 80 million individuals worldwide. It is estimated that 10-15% of couples of reproductive age are challenged by reproductive issues. Assisted reproduction techniques (ART) are responsible for more than 4% of live births. Our aim is to review the research on neurodevelopmental outcomes of newborns born after the implementation of assisted reproduction methods compared to those conceived naturally. We conducted a comprehensive search of the PubMed, Crossref and Google Scholar electronic databases for related articles up to June 2022 using the PRISMA guidelines. Our research revealed a large number of long term follow-up studies between 2 and 18 years of age, with comparable developmental outcomes. Many studies compared the effects of different infertility treatments against natural conception. The review of the literature revealed that ART is safe, as the majority of studies showed no effect on the neurodevelopmental outcomes of the offspring. In most cases when such an effect was observed, it could be attributed to confounding factors such as subfertility, multiple pregnancies and gestational age at delivery. Finally, the increase in the prevalence of neurodevelopmental disorders after ART, as described in studies with statistically significant results, is predominantly marginal, and given the low incidence of neurodevelopmental disorders in the general population, its clinical significance is debatable.
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Noda A, Ishikuro M, Obara T, Murakami K, Ueno F, Matsuzaki F, Onuma T, Watanabe Z, Shiga N, Iwama N, Hirotaka H, Otsuka T, Tachibana M, Tomita H, Saito M, Sugawara J, Kure S, Yaegashi N, Kuriyama S. Association between maternal infertility treatment and child neurodevelopment: findings from the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Miyagi and Iwate Prefectures, Japan. BMJ Open 2022; 12:e060944. [PMID: 35672073 PMCID: PMC9174802 DOI: 10.1136/bmjopen-2022-060944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study aimed to examine the association between infertility treatment and neurodevelopment in children at 2 and 3.5 years of age. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS The study population consisted of mother-child pairs who participated in the Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study in Miyagi and Iwate Prefectures, Japan. Pregnant women were recruited in obstetric clinics or hospitals and their children were followed up by the questionnaire. OUTCOME MEASURES The children's neurodevelopmental outcomes were assessed at 2 and 3.5 years of age using the Ages and Stages Questionnaire, third edition (ASQ-3), which consists of questions on five developmental domains. We performed a multivariate logistic regression analysis of the association between infertility treatment (including ovulation induction (OI), artificial insemination with husband's sperm (AIH) and assisted reproductive technology (ART)) and the clinical range of ASQ-3. RESULTS Of 9655 mother-child pairs, 273 (2.8%) and 487 (5.0%) were conceived through OI/AIH and ART, respectively. The odds of having developmental delays at 2 years of age were higher in children conceived through OI/AIH (OR, 1.36; 95% CI 1.00 to 1.85) and ART (OR, 1.36; 95% CI 1.07 to 1.72) than in those conceived naturally. Additionally, OI/AIH and ART were significantly associated with communication (OR, 1.93; 95% CI 1.25 to 2.98) and gross motor (OR, 1.50; 95% CI 1.08 to 2.09) delays, respectively. There were no statistically significant differences in the odds of having developmental delays at 3.5 years of age in children conceived through OI/AIH (OR, 1.13; 95% CI 0.79 to 1.61) and ART (OR, 1.03; 95% CI 0.78 to 1.37). CONCLUSION In this study, we found a significant association between infertility treatment and children's neurodevelopment at 2 years of age, whereas no statistically significant differences were found at 3.5 years of age.
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Affiliation(s)
- Aoi Noda
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Mami Ishikuro
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Taku Obara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Pharmaceutical Sciences, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Keiko Murakami
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumihiko Ueno
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fumiko Matsuzaki
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tomomi Onuma
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Zen Watanabe
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Naomi Shiga
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Noriyuki Iwama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hamada Hirotaka
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsui Otsuka
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Masahito Tachibana
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Hiroaki Tomita
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Psychiatry, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Psychiatry, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Disaster Psychiatry, International Research Institute of Disaster Science, Tohoku University, Sendai, Miyagi, Japan
| | - Masatoshi Saito
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Department of Maternal and Fetal Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Junichi Sugawara
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shigeo Kure
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Pediatrics, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Nobuo Yaegashi
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Hospital, Sendai, Miyagi, Japan
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- Environment and Genome Research Center, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shinichi Kuriyama
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Miyagi, Japan
- Division of Molecular Epidemiology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
- International Research Institute of Disaster Science, Tohoku University, Sendai, Miyagi, Japan
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Verhaeghe C, Marchand-Martin L, Kaminski M, Gascoin G, Foix L'hélias L, Ancel PY, Bouet PE, Morgan AS. Neurodevelopment at 5 years of age for preterm-born children according to mode of conception: a cohort study. Am J Obstet Gynecol 2022; 227:606.e1-606.e21. [PMID: 35671779 DOI: 10.1016/j.ajog.2022.05.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/20/2022] [Accepted: 05/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Preterm delivery is a risk factor for sub-optimal neurodevelopment. Pregnancies conceived after medically-assisted reproduction - which includes in vitro fertilisation, with or without intracytoplasmic insemination, as well as induction of ovulation followed by intra-uterine insemination or timed intercourse - have a higher risk of preterm delivery. Few studies have evaluated the outcome at more than 2 years of age of such preterm-born children. OBJECTIVE To evaluate neurodevelopmental outcome at 5 ½ years of age of children born preterm according to the mode of conception (spontaneous versus medically-assisted reproduction). STUDY DESIGN 4349 children born between 24 and 34 weeks of gestation who survived to 5 ½ years of age in the 2011 French prospective national cohort study EPIPAGE-2 were included: 814 in the medically-assisted reproduction group (433 by in vitro fertilisation, with or without intracytoplasmic insemination, and 381 by induction of ovulation) and 3535 in the spontaneously conceived group. Neurodevelopmental outcomes studied were sensory (hearing and vision) impairments, cerebral palsy, cognition and developmental coordination disorders. Multivariate analyses were performed with generalised estimating equation models adjusted for gestational age, antenatal steroids and social characteristics. All analyses were performed following multiple imputation. Sensitivity analyses were performed with the populations of singletons and cases with complete data. RESULTS No differences in cerebral palsy (adjusted odds ratio =1.00, 95% confidence interval 0.67-1.49), neurodevelopmental impairment (adjusted odds ratio=1.09; 95% confidence interval 0.82-1.45), or developmental coordination disorders (adjusted odds ratio=0.75; 95% confidence interval 0.50-1.12) were found between children born following medically-assisted reproduction and children born following spontaneous conception after adjustment for sociodemographic factors. For proportions of children with an intelligence quotient below one and two standard deviations, there were no differences between those born after medically-assisted reproduction or spontaneous pregnancy (respectively, adjusted odds ratio= 0.99 95% confidence interval 0.80-1.23, and adjusted odds ratio=1.14; 95% confidence interval 0.83-1.56). In subgroup analyses, no differences were seen between children born following induction of ovulation nor among those conceived through in vitro fertilisation when compared to children conceived spontaneously. Sensitivity analyses were consistent with the main results. CONCLUSION In this cohort of preterm born children, there was no evidence of an impact of the mode of conception on neurodevelopmental outcomes at 5 ½ years of age.
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Affiliation(s)
- Caroline Verhaeghe
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, F-75006, Paris, France; Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers, France
| | - Laetitia Marchand-Martin
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, F-75006, Paris, France
| | - Monique Kaminski
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, F-75006, Paris, France
| | - Géraldine Gascoin
- Department of Neonatology, Hôpital des Enfants, CHU Toulouse, 31059 Toulouse, France
| | - Laurence Foix L'hélias
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, F-75006, Paris, France; Sorbonne University, Paris, France; Department of Neonatal Pediatrics, Trousseau Hospital, Assistance Publique - Hôpitaux de Paris, 75012 Paris, France
| | - Pierre-Yves Ancel
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, F-75006, Paris, France; Clinical Investigation Center P1419, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, CHU d'Angers, 4, rue Larrey, 49033 Angers, France
| | - Andrei S Morgan
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRAE, F-75006, Paris, France; Elizabeth Garrett Anderson Institute for Women's Health London, University College London, London, UK; Department of Neonatalogy, Port-Royal Hospital, Assistance Publique - Hôpitaux de Paris, 75014 Paris, France.
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8
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Leblond M, Parent S, Castellanos-Ryan N, Lupien SJ, Fraser WD, Séguin JR. Transition from preschool to school: Children's pattern of change in morning cortisol concentrations. Psychoneuroendocrinology 2022; 140:105724. [PMID: 35325645 DOI: 10.1016/j.psyneuen.2022.105724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/26/2022]
Abstract
Many studies show a general increase in stress hormones at the exposure to school entry, but inconsistencies among them due to small samples with varying methodologies and very few time-points, preclude robust conclusions. The current study aimed to describe the pattern of morning cortisol concentration in children across the transition from preschool to school by examining whether we could identify a response to the school entry, but also an anticipatory stress response (pre-entry) and a stress adaptation response (post-entry). We further tested the robustness of this pattern across several characteristics. Participants were 384 children recruited from two cohorts of the 3D pregnancy study, and followed across their transition from preschool to kindergarten. Children's morning salivary cortisol samples were collected over five time-points: twice before school entry, once at school entry and twice after school entry (one sample per time-point). Although no anticipatory stress response was observed two weeks before school entry, latent growth curve models showed that most children's morning cortisol concentrations increased during the first two weeks of school, and was not associated with any sociodemographic characteristics, supporting the hypothesis that school entry is a normative environmental stressor. In contrast, two months after school entry, some children showed stress adaptation whereas others showed a prolonged stress response to school entry. This between-children variance could not be explained by any specific sociodemographic characteristic. This study showed that the morning stress response rises at school entry and is sustained for at least two weeks in most children. However, the observed variability in the stress adaptation response remains to be elucidated and linked to functional correlates.
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Affiliation(s)
- Maggy Leblond
- Department of Psychology, University of Montreal, PO BOX 6128 Centre-ville STN, Montreal, QC H3C 3J7, Canada; Centre Hospitalier Universitaire (CHU) Ste-Justine Research Center, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada
| | - Sophie Parent
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Center, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada; School of Psychoeducation, University of Montreal, PO BOX 6128 Centre-ville STN, Montréal, QC H3C 3J7, Canada
| | - Natalie Castellanos-Ryan
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Center, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada; School of Psychoeducation, University of Montreal, PO BOX 6128 Centre-ville STN, Montréal, QC H3C 3J7, Canada
| | - Sonia J Lupien
- Department of Psychology, University of Montreal, PO BOX 6128 Centre-ville STN, Montreal, QC H3C 3J7, Canada; Department of Psychiatry and Addictology, University of Montreal, PO BOX 6128 Centre-ville STN, Montréal, QC H3C 3J7, Canada; Institut Universitaire en Santé Mentale de Montréal Research Center, 7331 rue Hochelaga, Montréal, QC H1N 3V2, Canada
| | - William D Fraser
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Center, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada; Department Obstetrics and Gynecology, University of Sherbrooke, 3001, 12e avenue Nord, Sherbrooke, QC J1H 5N4, Canada; Centre hospitalier universitaire de Sherbrooke (CHUS) Research Center, 3001 12e Avenue Nord, Aile 9, Porte 6, Sherbrooke, QC J1H 5N4, Canada
| | - Jean R Séguin
- Centre Hospitalier Universitaire (CHU) Ste-Justine Research Center, 3175 Côte-Sainte-Catherine Road, Montréal, QC H3T 1C5, Canada; Department of Psychiatry and Addictology, University of Montreal, PO BOX 6128 Centre-ville STN, Montréal, QC H3C 3J7, Canada.
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9
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Szele AS, Gáll JM, Nagy BE. 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. Ital J Pediatr 2022; 48:69. [PMID: 35527293 PMCID: PMC9080178 DOI: 10.1186/s13052-022-01259-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
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.
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10
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Zareii A, Davoodi S, Alborzi M, Moghadam ME, Askary E. Co-administration of GnRH agonists with vaginal progesterone compared to vaginal progesterone in luteal phase support of the frozen-thawed embryo transfer cycle: An RCT. Int J Reprod Biomed 2021; 19:863-872. [PMID: 34805726 PMCID: PMC8595909 DOI: 10.18502/ijrm.v19i10.9817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 09/01/2020] [Accepted: 11/24/2020] [Indexed: 12/02/2022] Open
Abstract
Background Since progesterone alone does not seem to be enough for luteal phase support (LPS), especially in frozen embryo transfer (FET) cycles, so gonadotropin-releasing hormone agonist (GnRH-a) is suggested as an adjuvant therapy in combination with progesterone for LPS. Objective To evaluate the effects of the administration of GnRH-a with vaginal progesterone compared to vaginal progesterone alone in luteal phase support of the frozen-thawed embryo transfer cycles. Materials and Methods In this randomized controlled clinical trial, 240 infertile women who were candidates for FET were evaluated into two groups (n = 120/each). Group I received 400 mg vaginal progesterone twice a day from the time of transfer. The second group received vaginal progesterone and also 0.1 mg diphereline on days 0, 3, and 6 of FET for LPS. Finally, the clinical and ongoing pregnancy rates, and the implantation, and spontaneous abortion rates were compared in two groups. Results Results showed that there was no significant difference between the mean age of women and the duration of infertility (p = 0.78, p = 0.58, respectively). There were no significant differences between groups in the terms of implantation and spontaneous abortion rates (p = 0.19, p = 0.31, respectively). However, in terms of clinical and ongoing pregnancy rates, the significant differences were seen between groups (p = 0.008 and p = 0.005, respectively). Conclusion Co-administration of GnRH-a and vaginal progesterone in LPS may be superior to vaginal progesterone alone in women who underwent a frozen-selected embryo transfer cycle.
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Affiliation(s)
- Afsoon Zareii
- Infertility Division, Infertility Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sara Davoodi
- Infertility Division, Infertility Research Center, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahshid Alborzi
- Infertility Division, School of Medicine, Jahrom University of Medical Sciences, Jahrom, Iran
| | | | - Elham Askary
- Department of Obstetrics and Gynecology, Laparoscopy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Roychoudhury S, Lodha A, Synnes A, Abou Mehrem A, Canning R, Banihani R, Beltempo M, Theriault K, Yang J, Shah PS, Soraisham AS, Ting J, Abou Mehrem A, Alvaro R, Adie M, Ng E, Pelausa E, Beltempo M, Claveau M, Barrington K, Lapoint A, Ethier G, Drolet C, Piedboeuf B, Afifi J, Dahlgren L, Wood S, Metcalfe A, O’Quinn C, Helewa M, Taboun F, Melamed N, Abenhaim H, Wou K, Gratton R, Boucoiran I, Taillefer C, Theriault K, Allen V, Synnes A, Grunau R, Hendson L, Moddemann D, de Cabo C, Nwaesei C, Church P, Banihani R, Pelausa E, Nguyen KA, Khairy M, Beltempo M, Dorval V, Luu TM, Bélanger S, Afifi J. Neurodevelopmental outcomes of preterm infants conceived by assisted reproductive technology. Am J Obstet Gynecol 2021; 225:276.e1-276.e9. [PMID: 33798481 DOI: 10.1016/j.ajog.2021.03.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/16/2021] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
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.
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Qu D, Li Y. Multiple-dose versus single-dose gonadotropin-releasing hormone agonist after first in vitro fertilization failure associated with luteal phase deficiency: A randomized controlled trial. J Int Med Res 2021; 48:300060520926026. [PMID: 32495663 PMCID: PMC7273566 DOI: 10.1177/0300060520926026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate the efficacy and safety of multiple- versus single-dose gonadotropin-releasing hormone agonist (GnRH-a) addition to luteal phase support (LPS), in patients with a first in vitro fertilization (IVF) failure associated with luteal phase deficiency (LPD). Methods Eighty patients with a first IVF failure associated with LPD were randomly assigned into single-dose and multiple-dose GnRH-a groups. In the second IVF attempt, patients in the single-dose group were given standard LPS plus a single dose of GnRH-a 6 days after oocyte retrieval. Patients in the multiple-dose group received standard LPS plus 14 daily injections of GnRH-a. Children conceived were followed up for 2 years. Results Pregnancy (67.5% vs. 42.5%), clinical pregnancy (50.0% vs. 22.5%), and live birth rates (42.5% vs. 20.0%) were significantly higher in the multiple-dose versus single-dose GnRH-a group. Patients in the multiple-dose GnRH-a group had significantly higher progesterone levels 14 days after oocyte recovery (35.9 vs. 21.4 ng/mL). No significant difference existed in the status at birth or developmental and behavior assessments of 2-year-old children conceived in both groups. Conclusions Daily addition of GnRH-a to standard LPS can achieve better pregnancy outcomes with a sustained safety profile in patients with a first IVF failure associated with LPD.
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Affiliation(s)
- Danni Qu
- Medical Center for Human Reproduction, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Yuan Li
- Medical Center for Human Reproduction, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Shats M, Fenchel D, Katz G, Haas J, Machtinger R, Gat I, Orvieto R, Kedem A. Obstetric, neonatal and child development outcomes following assisted hatching treatment: a retrospective cohort study. Gynecol Endocrinol 2021; 37:41-45. [PMID: 32338095 DOI: 10.1080/09513590.2020.1756248] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Assisted hatching (AH) involves artificial disruption of the zona pellucida prior to embryo transfer. The purpose of this study is to examine the safety of AH technique and its effect on obstetrical, perinatal and neonatal outcomes and risk of developmental delay. This is a retrospective cohort of ART cycles using laser AH technique. The study group consisted of 120 cases of AH cycles resulting in singleton pregnancies and live births compared with 113 control cases. A current phone questionnaire was conducted to assess child development in the first year of life. AH was not associated with increased risk for all obstetrical and perinatal outcomes examined including PPROM, gestational diabetes, hypertensive diseases of pregnancy, delivery by cesarean section, gestational age at delivery, low birth weight (LBW), preterm birth and neonatal Apgar score (p>.05). No significant differences were observed between AH and control group in rates and risk of congenital malformations (5.8 vs. 4.4%, respectively, OR 1.33, 95% CI 0.41-4.34) and developmental delay (19.2 vs. 12.8%, respectively, OR 1.62, 95% CI 0.74-3.52). AH did not increase the risk of obstetrical and neonatal complications in singleton pregnancies, including congenital malformations and child developmental delay. AH may therefore be considered a safe method of ART.
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Affiliation(s)
- Maya Shats
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Fenchel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Katz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jigal Haas
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ronit Machtinger
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raoul Orvieto
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Kedem
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Ramat-Gan, affiliated with the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Huang X, Fu J. Association Between Assisted Reproductive Technology and White Matter Injury in Premature Infants: A Case-Control Study. Front Pediatr 2021; 9:686670. [PMID: 34513759 PMCID: PMC8429486 DOI: 10.3389/fped.2021.686670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 08/02/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: Whether there is a link between assisted reproductive technology (ART) and brain damage in premature infants remains unclear. The aim of this study was to determine whether premature infants conceived by ART are at a greater risk of developing white matter injury (WMI), as detected by magnetic resonance imaging (MRI) or diffusion-weighted imaging (DWI) within 14 days, than those naturally conceived (NC). Methods: A retrospective case-control study was conducted on singleton premature infants with a gestational age of ≥28 weeks and <34 weeks delivered between 2017 and 2019 at Shengjing Hospital, China Medical University. This study included 638 live births that were stratified into case group (n = 218) and control group (n = 420), depending on the presence or absence of WMI. The exposure proportion of ART was compared between the case and control groups, and a logistic regression model was used to identify whether ART was an independent risk factor for WMI. Results: In the univariate analysis, the exposure proportion of ART conception was higher in cases than in controls (12.84 vs. 7.38%, p = 0.024). According to the multivariable analysis, after adjustment for other variables, the association between ART and WMI remained significant (1.82; 95% confidence interval, 1.04-3.21; P = 0.038). Conclusions: Singleton premature infants conceived by ART have a higher risk of WMI than NC infants. Given that ART is an independent risk factor for WMI in premature infants, more attention should be paid to neurodevelopmental outcomes in this group.
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Affiliation(s)
- Xuejiao Huang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - JianHua Fu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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15
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Vo MT, Le TMC, Le TQ, Do DV, Ngo MX. Comparison of psychomotor development among children conceived through icsi in-vitro-fertilisation and naturally at 5 through 30 months of age, Vietnam. Eur J Obstet Gynecol Reprod Biol 2020; 258:157-161. [PMID: 33429165 DOI: 10.1016/j.ejogrb.2020.12.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 10/21/2020] [Accepted: 12/13/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE(S) To compare psychomotor development during 5 months to 30 months of age among children who were conceived via ICSI in-vitro fertilization to those conceived naturally. STUDY DESIGN Prospective cohort study was conducted during 2017-2018 with children visiting Tu Du Hospital for scheduled health checks. We randomly recruited 935 five-to-thirty-month-old children and distributed them into two groups for comparison: a group of 426 ICSI/IVF children and a group of 509 Naturally Conceived (NC) children. A team of pediatric mental health professionals used the revised Brunet-Lézine scale to directly examine those children and assess their Developmental Quotient (DQ). Controlling confounders with Propensity Score Matching (PSM), we analyzed and compared psychomotor development in 421 IVF children conceived by intracytoplasmic sperm injection (ICSI) against 421 NC. RESULT(S) At DQ cut-off point of 85, study data pinpointed no difference in such single DQs as motor posture, sociability and global scores between the two cohort groups. However, there was a difference in coordination and language DQs. IVF group's low-score proportion for coordination was 2.16 times that of NC group [95 % CI: 1.11-4.21] and its low-score proportion for language was 2.15 times that of NC group [95 % CI: 1.15-4.01]. CONCLUSION This study showed that IVF was not completely free from adverse effects. At the age of five to thirty months, IVF children would develop language and motor coordination more slowly than NC children, suggesting IVF should be done only when needed.
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Affiliation(s)
- Minh Tuan Vo
- University of Medicine & Pharmacy at Ho Chi Minh City, Viet Nam.
| | | | | | - Dung Van Do
- University of Medicine & Pharmacy at Ho Chi Minh City, Viet Nam.
| | - Minh Xuan Ngo
- Pham Ngoc Thach University of Medicine at Ho Chi Minh City, Viet Nam.
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16
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Zheng D, Nguyen QN, Li R, Dang VQ. Is Intracytoplasmic Sperm Injection the Solution for all in Unexplained Infertility? Semin Reprod Med 2020; 38:36-47. [PMID: 33152769 DOI: 10.1055/s-0040-1719085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Affiliation(s)
- Danni Zheng
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.,Beijing Advanced Innovation Center for Genomics, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | | | - Rong Li
- Department of Obstetrics and Gynecology, Center for Reproductive Medicine, Peking University Third Hospital, Beijing, China.,National Clinical Research Center for Obstetrics and Gynecology, Beijing, China.,Key Laboratory of Assisted Reproduction, Ministry of Education, Beijing, China.,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China.,Beijing Advanced Innovation Center for Genomics, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China
| | - Vinh Q Dang
- IVFMD, My Duc Hospital, Ho Chi Minh, Vietnam.,HOPE Research Center, My Duc Hospital, Ho Chi Minh, Vietnam
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17
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Kenyhercz F, Nagy BE. A new perspective: Establishing developmental profiles of premature infants based on Bayley-III scores at age 2. APPLIED NEUROPSYCHOLOGY. CHILD 2020; 11:125-132. [PMID: 32530722 DOI: 10.1080/21622965.2020.1771338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Longitudinal and cross-sectional studies in early childhood generally focus on different developmental areas separately. The aim of this study is to identify the most common developmental profiles regarding cognitive, language and motor skills among low birthweight (LBW) children. Our sample included 208 LBW children examined at 24-28 months. We used cluster analysis to identify developmental profiles based on the scores of the Bayley-III Cognitive, Language and Motor scales. We found three consistent profiles (High, Mildly Delayed and Severely Delayed) and three inconsistent, average profiles (with High Expressive Language, with Mildly Delayed Expressive Language and with Severely Delayed Language). Socioeconomic status, maternal education, in vitro fertilization, plurality and chronic morbidities were significantly related to the clusters. Cluster analysis might be an effective method to identify developmental profiles of preterm (and other at-risk) children, which might result in a more complex understanding of cognitive and psychomotor development in early childhood.
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Affiliation(s)
- Flóra Kenyhercz
- Faculty of Medicine, Department of Pediatrics, Kálmán Laki Doctoral School, University of Debrecen, Debrecen, Hungary
| | - Beáta Erika Nagy
- Faculty of Medicine, Department of Pediatrics, Pediatric Psychology and Psychosomatic Unit, University of Debrecen, Debrecen, Hungary
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18
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Sánchez-Soler MJ, López-González V, Ballesta-Martínez MJ, Gálvez-Pradillo J, Domingo-Martínez R, Pérez-Fernández V, Guillén-Navarro E. Evaluación del desarrollo psicomotor hasta los 3 años de edad de niños españoles concebidos por técnicas de reproducción asistida (FIV/ICSI): estudio prospectivo de cohorte controlado. An Pediatr (Barc) 2020; 92:200-207. [DOI: 10.1016/j.anpedi.2019.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 07/12/2019] [Accepted: 07/17/2019] [Indexed: 02/05/2023] Open
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19
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Assessment of psychomotor development of Spanish children up to 3 years of age conceived by assisted reproductive techniques: Prospective matched cohort study. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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Esteves SC, Roque M, Bedoschi G, Haahr T, Humaidan P. Intracytoplasmic sperm injection for male infertility and consequences for offspring. Nat Rev Urol 2019; 15:535-562. [PMID: 29967387 DOI: 10.1038/s41585-018-0051-8] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
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.
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Affiliation(s)
- Sandro C Esteves
- ANDROFERT, Andrology and Human Reproduction Clinic, Campinas, Brazil. .,Department of Surgery (Division of Urology), Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil. .,Faculty of Health, Aarhus University, Aarhus, Denmark.
| | - Matheus Roque
- ORIGEN, Center for Reproductive Medicine, Rio de Janeiro, Brazil
| | - Giuliano Bedoschi
- Division of Reproductive Medicine, Department of Gynecology and Obstetrics, University of São Paulo (USP), São Paulo, Brazil
| | - Thor Haahr
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
| | - Peter Humaidan
- Faculty of Health, Aarhus University, Aarhus, Denmark.,Fertility Clinic, Skive Regional Hospital, Skive, Denmark
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21
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Barbuscia A, Mills MC. Cognitive development in children up to age 11 years born after ART-a longitudinal cohort study. Hum Reprod 2018; 32:1482-1488. [PMID: 28541549 PMCID: PMC5850752 DOI: 10.1093/humrep/dex102] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/12/2017] [Indexed: 11/14/2022] Open
Abstract
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.
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Affiliation(s)
- Anna Barbuscia
- Department of Sociology and Nuffield College, University of Oxford, Manor Road, OxfordOX1 3UQ, UK
| | - Melinda C Mills
- Department of Sociology and Nuffield College, University of Oxford, Manor Road, OxfordOX1 3UQ, UK
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22
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The impact of fertility treatment on the neonatal respiratory outcomes and amniotic lamellar body counts in twin pregnancies. Clin Chim Acta 2018; 484:192-196. [PMID: 29860037 DOI: 10.1016/j.cca.2018.05.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND To elucidate the impact of fertility treatment on neonatal respiratory outcomes and amniotic lamellar body counts (LBCs) in twin pregnancies. METHODS One hundred ninety twin pairs, including 99 dichorionic twin (DCT) and 91 monochorionic twin (MCT) pairs were registered at our institutions. All amniotic fluid samples were obtained from each sac at cesarean section. Samples were analyzed immediately after arrival at the laboratory without centrifugation. We divided the patients into 3 groups: the no therapy group (natural conception), the induced ovulation group (with or without intrauterine insemination), and the assisted reproductive technology (ART) group (in vitro fertilization or intracytoplasmic sperm injection). RESULTS No statistically significant associations between the fertility treatment and the rates of neonatal RDS/TTN were observed in the whole study population (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.45-2.00), DCT (OR, 0.86; 95%CI, 0.30-2.47), and MCT (OR, 1.45; 95%CI, 0.41-5.11). In addition, there was no association between the fertility treatment and neonatal RDS/TTN in the propensity score analysis of the whole study population (OR, 1.25; 95%CI, 0.57-2.74). CONCLUSIONS None of the individual types of fertility treatment had a direct impact on respiratory disorders such as RDS and TTN in twin infants.
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Pereira N, O’Neill C, Lu V, Rosenwaks Z, Palermo GD. The safety of intracytoplasmic sperm injection and long-term outcomes. Reproduction 2017; 154:F61-F70. [DOI: 10.1530/rep-17-0344] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 07/10/2017] [Accepted: 07/14/2017] [Indexed: 01/09/2023]
Abstract
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.
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Abstract
Most IVF-conceived children are healthy, but IVF has also been associated with adverse obstetric and perinatal outcomes as well as congenital anomalies. There is also literature suggesting an association between IVF and neurodevelopmental disorders as well as potentially long-term metabolic outcomes. The main driver for adverse outcomes is the higher risk of multiple gestations in IVF, but as the field moves toward single embryo transfer, the rate of multiple gestations is decreasing. Studies have shown that singleton IVF pregnancies still have a higher incidence of adverse outcomes compared to unassisted singleton pregnancies. Infertility itself may be an independent risk factor. Animal models suggest that epigenetic changes in genes involved in growth and development are altered in IVF during the hormonal stimulation and embryo culture. Further animal research and prospective human data are needed to elucidate the mechanisms by which IVF may contribute to adverse outcomes and to decrease risks.
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Affiliation(s)
- Chantae S Sullivan-Pyke
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Suneeta Senapati
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104.
| | - Monica A Mainigi
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
| | - Kurt T Barnhart
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Pennsylvania, 3701 Market St, Suite 810, Philadelphia, PA 19104
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