Hart, R. J., & Wijs, L. A. (2022). The longer-term effects of IVF on offspring from childhood to adolescence. Front Reprod Health. https://doi.org/10.3389/frph.2022.1045762
Hart RJ, Wijs LA. The longer-term effects of IVF on offspring from childhood to adolescence. Front Reprod Health. 2022. doi:10.3389/frph.2022.1045762
Hart, R. J., and L. A. Wijs. "The longer-term effects of IVF on offspring from childhood to adolescence." Front Reprod Health, 2022.
School of Women's and Infants' Health; The University of Western Australia, King Edward Memorial Hospital and Fertility Specialists of Western Australia; Subiaco, Perth Australia
RRM Academy Synopsis
Health of IVF-conceived teens appears reassuring in a 2022 review
The authors of a 2022 narrative review say the long-term health evidence for ART-conceived children appears reassuring. The review draws heavily on one Western Australian cohort. At age 14, clinical depression affected about 13 out of 100 ART-conceived teens and about 9 out of 100 peers. The same cohort found no difference at 17.
Key Findings
UK hospital records covered children born through ART, with a mean age of 12.9 years. Their chance of any hospital stay ran slightly above that of naturally conceived children (hazard ratio 1.08).
At age 17, 163 ART offspring and 1,457 Raine Study participants showed no differences in blood pressure or heart rate. ART-conceived females had a lower BMI. Males did not differ significantly.
Clinical depression at 14 affected 12.6% of ART-conceived teens and 8.5% of naturally conceived teens, with no difference detected at 17. Raine teens with subfertile non-ART parents: 13.7%. With fertile parents: 6.9%.
At age 14, 152 ART participants and 1,845 Raine participants showed no difference in current asthma. Hay fever, food allergies and positive skin prick tests were more common in the ART group.
In Melbourne, 193 young adults conceived through ART scored higher on a quality of life assessment than 86 naturally conceived young adults, most clearly in social relationships and environment.
Interpretation
The paper is a narrative mini review whose lead author is affiliated with fertility clinics, and it pools no data. Many adolescent results come from one Western Australian cohort born through ART before 2001, compared with a population birth cohort. Observational comparisons like these show associations only. The authors name small samples, short follow-up, differing definitions across studies and fast-changing ART techniques as limits. Only 12% of the Western Australian group were conceived with ICSI. The adult results reported come from one Melbourne group.
RRM Context
The review lists preterm birth, low birth weight and congenital malformations as short-term risks for ART-conceived children. It reports that trouble getting pregnant is itself associated with pregnancy complications and malformations, though it calls this disputed. IVF bypasses infertility without diagnosing the cause. Restorative reproductive medicine evaluates both partners to find and treat that cause.
Our editorial summary of this paper, not the article's abstract.
Abstract
It is well established that there are increased pregnancy-related complications for a woman who conceives through assisted reproductive treatment (ART). Furthermore, it is known that the risk to the child born is greater, believed to be related to prematurity and growth restriction. Studies have also reported epigenetic changes in the DNA of offspring conceived through ART. In addition, it is believed that they have a greater risk of congenital malformations, although some of these risks may relate to underlying infertility, rather than the ART treatment per se. As a result, it may be expected that there is a greater risk to the longer-term health of the child who is born from ART; however, evidence about the long-term health of children conceived through ART is reassuring. Even though, it is recognised that many of the studies in this field come with limitations. Low numbers of participants is one of the major limitations, which makes subgroup analyses for diverse types of ART, or diverse types of infertility, not feasible. Furthermore, studies are often limited by short follow-up periods because of the difficulty and costs involved in longitudinal study designs. In addition, the rapid changes over time in ART limit the generalisability and significance of long-term findings. Well-designed studies investigating the long-term health outcomes of ART-conceived offspring and the potential influences of various aspects of the ART procedure, as well as studies of the potential underlying epigenetic mechanisms, are imperative. Furthermore, conclusions from childhood hospitalisation data from the United Kingdom, the long-term follow-up and quality of life study from researchers in Melbourne, and the data published from the Western Australian Growing Up Healthy Study will go a long way to help reassure current and prospective parents who may require ART to conceive.