Assisted Reproduction Safety and Risks
RRM Academy Synopsis
ART was linked to higher autism risk in children in a meta-analysis
ART was associated with a higher risk of autism in children across 11 pooled studies. The meta-analysis combined 3 cohort studies and 8 case-control studies on assisted reproductive technology (ART), including IVF and ICSI, and autism spectrum disorder (ASD) in offspring. The pooled risk ratio was 1.35.
Key Findings
- The meta-analysis included 11 studies (3 cohort and 8 case-control) with 8,161,225 participants, of whom 46249 had ASD.
- Pooled across all 11 studies, ART was associated with higher ASD risk: RR = 1.35, 95% CI: 1.09–1.68, P = 0.007.
- By design, the 3 cohort studies gave RR 1.30 (95% CI 0.93–1.83) and the 8 case-control studies gave RR 1.40 (95% CI 0.99–1.98).
- By quality score, the 3 high-quality studies gave RR 1.07 (95% CI 1.00–1.14) and the 4 low-quality studies gave RR 2.20 (95% CI 1.63–2.97).
- Heterogeneity across the 11 studies was I² = 88.1%. After removing the 3 studies identified as its main sources, RR = 1.18, 95% CI: 1.03–1.34, P = 0.016.
Interpretation
The meta-analysis pools observational studies, so it reports an association between ART and autism. The authors call ART likely an independent risk factor. They also state that residual confounding is a concern and that factors tied to the parents' fertility problems are hard to rule out. The authors note that only 1 included study analyzed maternal age, that they could not compare IVF with ICSI, and that only English-language studies were included. The authors advise caution and call for population-based prospective cohort studies.
RRM Context
ART bypasses the reproductive system and leaves the reason for infertility unresolved. Restorative reproductive medicine looks for that reason in both partners. The authors list the parents' fertility problems among the factors hard to rule out.
Abstract
The association between the use of assisted reproductive technology (ART) and autism spectrum disorder (ASD) risk in offspring has been explored in several studies, but the result is still inconclusive. We assessed the risk of ASD in offspring in relation to ART by conducting a meta-analysis. A literature search in PubMed, Embase, and Web of Knowledge databases through April 30, 2016 was conducted to identify all the relevant records. Risk ratios (RRs) and 95% confidence intervals (95%CIs) were computed to analyze the strength of association by using fixed- or random-effect models based on heterogeneity test in total and subgroup analyses. Analysis of the total 11 records (3 cohort studies and 8 case-control studies) revealed that the use of ART is associated with higher percentage of ASD (RR = 1.35, 95% CI: 1.09-1.68, P = 0.007). In addition, subgroup analyses based on study design, study location and study quality were conducted, and some subgroups also showed a statistically significant association. Our study indicated that the use of ART may associated with higher risk of ASD in the offspring. However, further prospective, large, and high-quality studies are still required.
