Assisted Reproduction Safety and Risks

Risk of Cancer in Children Conceived by Assisted Reproductive Technology

Reigstad MM, Larsen IK, Myklebust TÅ, Robsahm TE, Oldereid NB, Brinton LA, Storeng R

Published March 2016 Pediatrics
DOI 10.1542/peds.2015-2061 PMID 26908669 PMC PMC5178823

RRM Academy Synopsis

Leukemia risk was higher in ART-conceived children in Norway

In a Norwegian national registry cohort of 1 628 658 children, leukemia risk was higher in ART-conceived children (hazard ratio 1.67). The study followed all eligible children born in Norway from 1984 to 2011. Overall cancer risk was not significantly elevated (hazard ratio 1.21).

Key Findings

  • The cohort held 1 628 658 children, including 25 782 conceived by ART. Of 4554 cancers recorded, 51 occurred in children conceived by ART.
  • Overall cancer risk in ART-conceived children was not significantly elevated, with HR 1.21 and 95% CI 0.90–1.63.
  • Leukemia risk was higher in ART-conceived children in the fully adjusted model (HR 1.67; 95% CI 1.02–2.73), based on 17 leukemia cases in the ART group.
  • Acute myeloid leukemia, with 5 cases in the ART group, had HR 2.63 (95% CI 1.04–6.64). Acute lymphoid leukemia had HR 1.16 (95% CI 0.60–2.27).
  • Hodgkin lymphoma risk was higher in ART-conceived children on small numbers, with HR 3.63 and 95% CI 1.12–11.72. The estimate rests on 3 cases among those children.

Interpretation

A registry cohort compares groups already defined by records. It reports associations. A hazard ratio above 1 means a higher rate of cancer over time in the ART group. The authors state that the data cannot separate the ART procedures from parental infertility as sources of risk. Paternal age and parental genetics were not adjusted for. The ART group was younger, with median follow-up of 6.9 years against 13.7 years, so the study may be underpowered to evaluate cancers arising later in childhood and adolescence. The authors advise caution with the acute myeloid leukemia and Hodgkin lymphoma estimates because few cases underlie them.

RRM Context

IVF and the other forms of ART go around the causes of infertility. Restorative reproductive medicine evaluates both partners to find those causes and treats them.

Abstract

An increasing number of children are born after assisted reproductive technology (ART), and monitoring their long-term health effects is of interest. This study compares cancer risk in children conceived by ART to that in children conceived without. The Medical Birth Registry of Norway contains individual information on all children born in Norway (including information of ART conceptions). All children born between 1984 and 2011 constituted the study cohort, and cancer data were obtained from the Cancer Registry of Norway. Follow-up started at date of birth and ended on the date of the first cancer diagnosis, death, emigration, or December 31, 2011. A Cox proportional hazards model was used to calculate hazard ratios (HR) and 95% confidence intervals (CI) of overall cancer risk between children conceived by ART and those not. Cancer risk was also assessed separately for all childhood cancer types. The study cohort comprised 1 628 658 children, of which 25 782 were conceived by ART. Of the total 4554 cancers, 51 occurred in ART-conceived children. Risk of overall cancer was not significantly elevated (HR 1.21; 95% CI 0.90-1.63). However, increased risk of leukemia was observed for children conceived by ART compared with those who were not (HR 1.67; 95% CI 1.02-2.73). Elevated risk of Hodgkin's lymphoma was also found for ART-conceived children (HR 3.63; 95% CI 1.12-11.72), although this was based on small numbers. This population-based cohort study found elevated risks of leukemia and Hodgkin's lymphoma in children conceived by ART.

Topics

By this author

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Assisted Reproduction › Safety and Risks › Long Term Child Outcomes
Marte Myhre Reigstad, Inger Kristin Larsen, Tor Åge Myklebust, Trude Eid Robsahm, Nan Birgitte Oldereid, Louise A Brinton, Ritsa Storeng
M Reigstad, I Larsen, T Myklebust, T Robsahm, N Oldereid, L Brinton, R Storeng
PMID 26908669 26908669 DOI 10.1542/peds.2015-2061 10.1542/peds.2015-2061 Reigstad et al. 2016, Reigstad 2016