Well over 5 million children have been born through the miracle of infertility treatment. That is good news indeed, not only for these kids, some of whom are now adults, but also for their parents. Despite the fact that in vitro fertilization (IVF), cryopreservation of embryos, and intracytoplasmic sperm injection (ICSI) have become almost routine, we know amazingly little about how these techniques affect the children in the long and the short term. We talked about these effects on yesterday’s Creating a Family show with Dr. Seetha Shankaran, Professor of Pediatrics and Director of Neonatal Perinatal Medicine at Wayne State University School of Medicine, and author of comprehensive analysis of the literature on childhood and young adult outcome following infertility treatment and published in the journal Fertility and Sterility
The Good News about How IVF Affects Kids’ Health
The good news is that what research exists is finding that IVF and other reproductive medicine technology does not look like it affects the physical growth of the children conceived, the timing of the onset of puberty, or their cognitive, behavioral or mental health. They were no more likely to be diagnosed with autism spectrum disorders (ASD) or attention deficit hyperactivity disorder. Children conceived through IVF are also not more likely to develop cancer.
The Bad News about How IVF Affects Kids’ Health
Children conceived through fertility treatment are significantly more likely to have neurological problems, for example cerebral palsy, than children conceived naturally, but this is due to the significantly higher occurrence of twins and premature birth. Research also suggests that children conceived via IVF are more likely to have higher blood pressure, higher blood sugar, and higher body mass indexes than the general population. You can listen to the show to hear more about this issue.
What We Desperately Need
Given how popular infertility treatment has become, it is amazing how little research has been done on the long-term effects on the children being conceived. For this research to be truly valuable it needs to cover a large number of children/adolescents/young adults and it needs to follow them over a long period of time. We need this research to inform the practice of reproductive medicine.
One of the roadblocks to doing this kind of in depth research on children conceived with IVF is the lack of a national database of children and parents. This is a controversial topic amongst parents that have used fertility treatment. Would you be willing for your child to be on such a database?
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Oh, and I did ask if my husband’s numbers get high enough if we can do straight ivf with no icsi. And the RE said it was not advisable because with my age (38), you want to make sure you get fertilization. I don’t know, it is all very confusing and probably more of an art than it is science for most REs.
Dawn, we didn’t have a choice with icsi, we had male factor. The one thing my RE said to us was that he thought the increased risk observed with icsi was driven by men who have severe infertility where they have to do do biopsies. My husband had low values but enough to find normal sperm. But who knows? I also asked if we can skip the fresh cycle and do frozen because the risk with frozen even with icsi, seems to go down. We opted for a shared risk program so we could not do that but there seems to be a discussion about doing away with the fresh cycle (current issue of fertility and sterility). At the end, our fresh cycle didn’t work out but our frozen so far is looking good. It’s very strange, you can do a lot of research going in, but once you start, you just don’t care and just want to get pregnant!
I haven’t listened to the podcast (I will after this) but I recently went to a series of talks about IVF outcomes and I was extremely dissatisfied with the amount of data that is out there. There are limitations to the data that we can get, because IVF is relatively new. At the meeting, the researchers agreed that we are going to get most of the answers from Scandinavia and other countries that have these large national registries. Even in these, it is really difficult to really get to answers because there are so many reasons for why people get IVF. THere isn’t enough people, say , to divide the IVF because of tubal factors, diminished ovarian reserve, male factor etc etc. And I suspect the risks will be different based on what type of infertility that gets you there. We were totally freaked out to do ICSI because most of the studies say that ICSI has the most increased risk for negative outcomes (although the absolute risk is still very small). My doctor went through the paper in NEJM with the South Australian study – but he said even with ICSI, probably the highest risks are associated with those who have to have TESE …basically men with extremely low values – but who knows? I am going go listen to the show now…but I have to say as potential future parents of IVF/ICSI child(ren) – this information really scares us the most.
AnonT, you’re absolutely right that we need more data. There are so many reasons why we have so few really good studies (large and long), but you’re right that the lack of a database of children conceived is one of them. Also, as you say, this is really complex stuff we’re talking about and teasing out cause would be hard under the best of circumstances.
Is ICSI something you will have a choice on? I have heard several doctors talk with concern about making ICSI a standard part of an IVF cycle unless it is truly necessary b/c of male factor infertility?
You’re probably right, Dawn.
Given how popular infertility treatment has become, it is amazing how little research has been done on the long-term effects on the children being conceived.
It is possible that it is BECAUSE of how popular IF treatment is, that so little research has been done – after all, if results are negative then that might put a dampener on things.
cb, it is kind of surprising, but I’m not as cynical as you as to the reasons why. We talked about the reasons at some length on the show. This type of research (large # of children followed over a long period of time) is expensive to do. In the US, there is no database of children conceived by IVF or other assisted reproduction, so that hampers research as well. There is also a weird sort of division in care–after 6-8 weeks the mother’s care switches from the infertility clinic to a regular obstetrician. Then after birth the child’s is cared for by a pediatrician and if their are problems by a specialist. Often, very often, the pediatrician or specialist does not even know that the child was conceived through fertility treatment. In fact, some women do not even tell their obstetrician that they had help getting pregnant.