Parents’ concerns regarding their ART children

General health in a cohort of children conceived after assisted reproductive technology in the United Kingdom: a population-based record-linkage study

BACKGROUND

Assisted reproductive technology use is increasing annually; however, data on long-term child health outcomes including hospital admissions are limited.

OBJECTIVE

This study aimed to examine the potential effects of assisted reproductive technology on any and cause-specific hospital admissions unrelated to perinatal diagnoses.

STUDY DESIGN

This was a population-based record-linkage study that included a previously established cohort of children born after assisted reproductive technology in the United Kingdom between 1997 and 2009 (n=63,877), their naturally conceived siblings (n=11,343), and matched naturally conceived population controls (n=127,544) linked to their postnatal health outcomes up to March 31, 2016 to provide robust risk estimates of the potential effects of assisted reproductive technology on any and cause-specific hospital admissions unrelated to perinatal diagnoses. In addition, comparison of hospital admissions by type of treatment was made. Cox regression was used to estimate the risk of hospital admission, and negative binomial regression was used to compare the number of hospital admissions per year.

RESULTS

This study had 1.6 million person-years of follow-up (mean, 12.9 years; range, 0-19 years), and the mean age at the time of first hospital admission was 6.5 years (range, 0-19 years). Singletons born after assisted reproductive technology had increased risk of any hospital admission compared with naturally conceived population controls (hazard ratio, 1.08; 95% confidence interval, 1.05-1.10) but not naturally conceived siblings (hazard ratio, 1.01; 95% confidence interval, 0.94-1.09). We observed increased risk of diagnoses related to neoplasms and diseases of the respiratory, musculoskeletal, digestive, and genitourinary systems, and lower risk of injury, poisoning, and consequences of external causes compared with naturally conceived population controls. Children born after intracytoplasmic sperm injection had a lower risk of hospital admission compared with those born after in vitro fertilization, although no such differences were observed between children born after fresh embryo transfers and those born after frozen embryo transfers.

CONCLUSION

Children born after assisted reproductive technology had greater numbers of hospital admissions compared with naturally conceived population controls. Attenuation of these differences in relation to their naturally conceived siblings suggested that this could be partially attributed to the influence of parental subfertility on child health, increased parental concerns, and an actual increase in morbidity in children born after assisted conception.

Cohort profile: a national, population-based cohort of children born after assisted conception in the UK (1992-2009): methodology and birthweight analysis

PURPOSE

To generate a large cohort of children born after assisted reproductive technology (ART) in the UK between 1992 and 2009, their naturally conceived siblings (NCS) and matched naturally conceived population (NCP) controls and linking this with health outcome data to allow exploration of the effects of ART. The effects of fresh and frozen embryo transfer on birth weight (BW) were analysed to test the validity of the cohort.

PARTICIPANTS

Children recorded on the Human Fertilisation and Embryology Authority (HFEA) register as being born after ART between 1992 and 2009, their NCS and matched NCP controls linked to Office for National Statistics birth registration dataset (HFEA-ONS cohort). This cohort was further linked to the UK Hospital Episode Statistics database to allow monitoring of the child's post-natal health outcomes up to 2015 (HFEA-ONS-HES subcohort).

FINDINGS TO DATE

The HFEA-ONS cohort consisted of 75 348 children born after non-donor ART carried out in the UK between 1 April 1992 and 31 July 2009 and successfully linked to birth registration records, 14 763 NCS and 164 823 matched NCP controls. The HFEA-ONS-HES subcohort included 63 877 ART, 11 343 NCS and 127 544 matched NCP controls further linked to health outcome data. The exemplar analysis showed that children born after fresh embryo transfers were lighter (BW difference: -131 g, 95% CI: -140 to -123) and those born after frozen embryo transfers were heavier (BW difference: 35 g, 95% CI: 19 to 52) than the NCP controls. The within-sibling analyses were directionally consistent with the population control analyses, but attenuated markedly for the fresh versus natural conception (BW difference: -54 g; 95% CI: -72 to -36) and increased markedly for the frozen versus natural conception (BW difference: 152 g; 95% CI: 113 to 190) analyses.

FUTURE PLANS

To use this cohort to explore the relationship between ART conception and short-term and long-term health outcomes in offspring.

[A survey of pubertal development in children born with assisted reproductive technology]

OBJECTIVE

To investigate the status of pubertal development in children born with assisted reproductive technology (ART).

METHODS

A retrospective analysis was performed on the pubertal development data of children born with ART in Peking University Third Hospital from 1994 to 2003 (ART group). The data in the cross-sectional study "Reports on the Physical Fitness and Health Research of Chinese School Students in 2010" were used as a control. The age at menarche and the age at spermarche were compared between the two groups. The status of pubertal development in the overweight and obese children in the ART group was evaluated to investigate the correlation between pubertal development and body mass index (BMI).

RESULTS

A total of 200 children born with ART were enrolled in this study, and 72 of them (41 males and 31 females) completed the survey (response rate=36.0%). In the ART group, the mean age at spermarche and the mean age at menarche were 13.9 years (95%CI: 13.7-14.3 years) and 12.2 years (95%CI: 11.8-12.6 years), respectively. There were no significant differences in the age at spermarche and the age at menarche between the ART and control groups (P>0.05). In the ART group, there were no significant differences in the age at spermarche and the age at menarche between the overweight and obese children and the normal weight children (P>0.05). There were also no significant differences in overweight rate and obesity rate between the children in the ART group and the adolescents in Beijing (P>0.05). In the ART group, there was no significant correlation between the age at spermarche or menarche and BMI (P>0.05).

CONCLUSIONS

No delayed or precocious puberty is observed in children born with ART. This is consistent with the normal control data. And there is no significant correlation between pubertal development and BMI in children born with ART.

Health and disease in children born after assistive reproductive therapies (ART

In vitro fertilisation (IVF) and other assisted reproductive therapies (ART) offer hope to subfertile couples worldwide. At least 5 million ART children have been born to date. Their health is an issue that is increasingly relevant: first, to those children and young adults themselves; second, to couples considering fertility treatment; and third, to the general population as ART has progressed from experimental treatment to routine practice. Many concerns about the potential risks to these children have been voiced with varying degrees of supportive evidence. This article summarises some key long-term data. Current evidence suggests that ART does increase risk of: higher order pregnancy (with its inherent pre- and perinatal risks); prematurity and low birth weight; congenital malformations in particular of the male urogenital system; imprinting disorders. Reassuringly, evidence points away from an increased overall cancer risk or differences in neurodevelopmental outcomes. Many unknowns remain, including future fertility and cardiovascular risks and risk of cerebral palsy.

Pubertal development of the first cohort of young adults conceived by in vitro fertilization in the United States

OBJECTIVE

To characterize pubertal development of the first generation of young adults born as a result of in vitro fertilization (IVF). Demographic, clinical, and body size characteristics were examined regarding developmental milestones.

DESIGN

Cross-sectional.

SETTING

Academic center.

PATIENT(S)

Young adults (18-26 years) conceived by IVF (no gamete/embryo manipulation) 1981-1990.

INTERVENTION(S)

Self-administered questionnaire.

MAIN OUTCOME MEASURE(S)

Age at puberty onset, body size.

RESULT(S)

Of 560 eligible young adults, 173 completed the survey (response rate 30.9%). We analyzed data on 166 respondents (71 male and 95 female). No cases of delayed or precocious puberty were observed in the study sample. As expected, age at puberty onset was significantly higher among male subjects (12.3 years) compared with female subjects (11.5 years). A few developmental milestones were predicted by maternal age and infertility diagnoses. For both genders, a direct association was noted between age at puberty onset and height achieved in young adulthood. Structural equation models suggested an inverse relationship of female gender with age at puberty onset and body mass index.

CONCLUSION(S)

In vitro fertilization-conceived young adults did not exhibit pubertal abnormalities. Female gender and age at puberty onset independently predicted body mass index of IVF offspring in young adulthood.

Growth of children conceived by IVF and ICSI up to 12years of age

Recent studies have given conflicting results regarding growth in children born following assisted reproductive treatments up to the age of 18years. It has been suggested that children conceived via IVF may be taller than naturally conceived children and that this may due to subtle epigenetic alteration of imprinted genes as a result of the IVF process. A prospective match-controlled study was performed to investigate the growth of children born in the UK following standard IVF and intracytoplasmic sperm injection (ICSI) up to the age of 12years. The study assessed 143 IVF and 166 ICSI children with 173 matched naturally conceived controls. Primary end-points were height and weight at various time points: birth, 5years, 7-9years and 10-12years. In addition, head circumference was assessed at birth. No significant differences were observed regarding head circumference, height and weight between the three groups at any of the time points. In conclusion, this preliminary study provides reassuring information regarding the growth of IVF and ICSI children up to 12years. Further studies must continue to investigate the growth and other outcomes in assisted-conception children as they develop through puberty into early adulthood.

Long-term health implications for children conceived by IVF/ICSI

In vitro fertilisation and intra-cytoplasmic sperm injection are well recognised techniques for assisted reproduction, helping over 85% of infertile couples conceive within a year, contributing to over 1% of the annual birth rate in the western world. There is currently limited data on the health of these children in later life as the techniques are relatively new. Certain trends have started to emerge with high order births proving to be responsible for a large proportion of premature and low-birth weight infants. The increased risk of perinatal morbidity and mortality associated with singleton births has been linked to the infertility of the couple rather than the techniques used. This theory has also been suggested to account for the increase in congenital malformations observed. No discrepancies in neurodevelopmental outcome of these children have been established and no detrimental psychological effects on the families have been reported. There has been an increase in childhood illness observed and the future fertility of these children is a major concern for many parents. Further follow up of these children is needed to fully establish the long-term health implications of in vitro fertilisation and intra-cytoplasmic sperm injection.

Assessment of the long-term and transgenerational consequences of perturbing preimplantation embryo development in mice

Perturbations of the development of preimplantation embryos may have long-term consequences for the health of progeny. There are no standardized methods for assessing such risks. The OECD/OCDE 416 Guideline for Testing of Chemicals (Two-Generation Reproduction Toxicity Study) is a standardized assay for detecting potential toxic effects of chemicals. The present study assessed the utility of this guideline for identifying long-term consequences of perturbing preimplantation development. Extended culturing of mammalian zygotes commonly results in retarded preimplantation development. Mouse zygotes were cultured in vitro for 96 h until the blastocyst stage (cultured blastocysts) or blastocysts were collected from the Day-3.5 uterus (in vivo blastocysts). The resulting blastocysts were transferred to the uteri of pseudopregnant recipients (P generation). Progeny from both treatments were mated for a further two generations (F1 and F2 generations). There was no effect of treatment group on gross fertility across the generations tested. Progeny of the cultured blastocysts had lower body weights to the time of weaning compared to in vivo blastocysts in the P and F1 generations, but not in the F2 generation. At maturity, there was no effect of treatment group on body weight, although thyroid weight was higher in the in vivo blastocyst group in the P generation, while the brain, pituitary, and kidneys were larger in the progeny of the cultured blastocysts of the F1 generation. The OECD/OCDE 416 assessment may have a role as a standardized test for the assessment of the biological consequences of perturbing the growth environment of the preimplantation embryo. Embryo culture influenced the somatometric parameters of the resulting progeny, some of which were maintained across a generation.