Assisted Reproductive Technology Infants Research Articles

Admission to hospital of singleton children born following assisted reproductive technology (ART)

Adverse perinatal outcomes are more common in singletons born following assisted reproductive technology (ART) and this would predict an increase in hospitalization during infancy and early childhood. We investigated hospital admissions during the first 3 years of life for all singleton children born in Western Australia between 1994 and 2000 [1328 ART, 162 350 spontaneously conceived (SC)]. ART infants had a significantly longer birth admission and were four times more likely to be admitted to neonatal intensive care units (NICU) than SC infants. ART children had a 60% greater risk of one or more admissions in their first year and an equal risk of admission in their second and third years. Their length of stay in hospital was longer in each age period. Maternal, infant and socio-economic confounders accounted for most of the increased admission risk in the first year. However, after adjustment, a 20% increase in the risk of admission to NICU (P < 0.05) and admission to hospital during the first year (P < 0.05) remained. Couples undertaking ART should be aware that ART infants are more likely to be admitted to a NICU, to be hospitalized in the first year of life and to stay in hospital longer than other children.

Developmental and Genetic Outcomes in Children Conceived Through Assisted Reproductive Technologies

After completing this article, readers should be able to: 1. Describe the outcomes of assisted reproductive technologies (ART) for singleton, twin, and other multiple births. 2. Describe the role of fertility in adverse outcomes seen with ART births. 3. Review the association of birth defects with ART. 4. Delineate the association of disease of genomic imprinting with ART. 5. Describe the relationship between ART and the subsequent incidence of neurodevelopmental sequelae. In the 1977 ruling “Carey v. Population Services International,” the United States Supreme Court ruled that the decision to bear children is constitutionally protected. (1) Significant interest already had been shown in the development and improvements of in vitro fertilization (IVF) for infertile couples. The first human pregnancy and human birth using IVF were reported by Steptoe and Edwards in the United Kingdom. (2) Their work resulted in the first baby born via reproductive technologies, Louise Brown, born on July 25, 1978, at Oldham General Hospital in Oldham, United Kingdom. (3) She was born via a planned cesarean section, and her birthweight was 2.61 kg. The first successful viable IVF in the United States was performed by Jones and Seager-Jones in 1981 in Norfolk, Virginia. (4) Assisted reproductive technologies (ART) have seen a recent surge in popularity. The Centers for Disease Control and Prevention (CDC) reported that 122,872 cycles of ART were initiated in 2003, resulting in the delivery of 48,756 neonates, (5) accounting for approximately 1% of all neonates delivered in the United States. The percentage is higher in many countries, including Denmark, where it is estimated that 5% of all deliveries are with the assistance of ART. (6) Couples pursue ART for myriad reasons, including tubal transport factors, ovulatory dysfunction, uterine factors, endometriosis, male- and female-specific factors, and when a cause of infertility is unknown. (5) It would be very …

Practitioner reporting of birth defects in children born following assisted reproductive technology: Does it still have a role in surveillance of birth defects?

National assisted reproductive technology (ART) data collections that rely on practitioners' reports of birth defects have consistently reported lower proportions of children with birth defects than record linkage studies that link ART infants to birth and malformation registers. We compared the birth defect data reported to the national Australian Assisted Conception Data Collection (ACDC) by practitioners at three Western Australian ART clinics with the birth defect data identified on the Western Australian Birth Defects Registry (WABDR) through record linkage of all the pregnancies conceived at these clinics to the WABDR. Cases are reported to the WABDR by multiple statutory and voluntary sources. We found that the national ACDC significantly underestimated the prevalence of birth defects in WA-born ART infants. Less than one-third of ART children identified with a major birth defect on the WABDR were reported to the ACDC. Although national ART data collections provide valuable information on pregnancy rates and short-term pregnancy outcomes such as multiple birth and birth weight, we strongly recommend that birth defect information used for patient counselling is preferentially drawn from large studies that have used record linkage to high-quality birth defect registers.

Assisted reproductive technologies and the risk of birth defects—a systematic review

The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF infants compared to spontaneously conceived infants have serious methodological limitations; despite this, most researchers have concluded that there is no increased risk. We carried out a systematic review to identify all papers published by March 2003 with data relating to the prevalence of birth defects in infants conceived following IVF and/or ICSI compared with spontaneously conceived infants. Independent expert reviewers used criteria defined a priori to determine whether studies were suitable for inclusion in a meta-analysis. Fixed effects meta-analysis was performed for all studies and reviewer-selected studies. Twenty-five studies were identified for review. Two-thirds of these showed a 25% or greater increased risk of birth defects in ART infants. The results of meta-analyses of the seven reviewer-selected studies and of all 25 studies suggest a statistically significant 30-40% increased risk of birth defects associated with ART. Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions. This information should be made available to couples seeking ART treatment.

Assisted reproductive technologies and birth outcomes: overview of recent systematic reviews

Several systematic reviews have been published recently on birth outcomes of infants conceived through assisted reproductive technologies (ART), compared with infants conceived spontaneously. These outcomes include perinatal mortality, preterm birth, low birthweight and birth defects. Methodological limitations of many of the individual studies (including small sample size, potential for bias in ascertainment of outcomes and considering singletons and multiples together) were obviated in these reviews by excluding studies where methods were considered inadequate, by conducting meta-analyses using data from all methodologically sound studies (small and large) and by examining singletons separately. Overall, the reviews indicate few differences between outcomes in ART twins compared with twins conceived spontaneously. However, in singleton ART infants, there are around two-fold increases in risk of perinatal mortality, low birthweight and preterm birth, about a 50% increase in small for gestational age and a 30-35% increase in birth defects, compared with singletons conceived spontaneously. Couples considering ART should be counselled about the increased risk of adverse outcomes. Epidemiologists, in conjunction with clinical and laboratory colleagues, should now focus on large, methodologically sound studies with long-term follow up that seek to identify the reasons for these increased risks and their long-term consequences, whether they are associated with particular technologies and causes of infertility, and how they might be reduced.

Assisted reproduction and birth defects

Recent publications have indicated the potential for increased birth defect rates in children conceived through assisted reproductive technology (ART). This study was designed to determine the risk of birth defects in ART-conceived children (including IVF, ZIFT, and ICSI) compared to a matched control population. A retrospective cohort study of all children conceived using ART from 1989–2002 through the University of Iowa's Infertility Clinic. Comparison is made with a matched control group of children born in Iowa during that same period. Case children were matched with multiple controls for plurality, maternal age, year of birth, race, and county of delivery. Outcome data was obtained from birth and death certificates, and from the Iowa Birth Defects Registry, an active state-wide surveillance system which audits all Iowa hospitals for birth defects in liveborn and stillborn children through one year of age. Birth defects were classified as major or minor, multiple or isolated, and by organ system as well as individual defect. ART is associated with a small but significant increase in major birth defects in all births and when restricted to singleton births only. Among singletons, birth defect rates are 3.7% for controls and 5.9% for ART (OR 1.62, 95% CI 1.12, 2.34). Multiple gestation is an independent risk factor for major birth defects across all groups. There is no increased risk of multiple (versus isolated) defects between the infertility treatment group and controls. In the ART population, there is a small but significantly increased risk of major birth defects in certain organ systems (cardiovascular, musculoskeletal, and recognized syndromes). Neither ICSI nor cryopreservation confers any additional risk of birth defects or is associated with any specific types of birth defects (e.g., urogenital) as has been noted by previous authors. No significant differences in birth defect rates were noted among the various treatment methods (IVF, GIFT, ZIFT). Singleton ART infants are at increased risk of prematurity and operative deliveries. There is a small but statistically increased risk of major birth defects among children conceived through ART. While we note an increased rate of birth defects, this is not as marked an increase as has been reported in recent, similarly designed studies. ICSI and embryo cryopreservation do not further increase this risk. Birth defect rates in a few specific organ system groups are increased among children conceived through infertility treatments versus controls. Birth defect rates are increased across the various ART procedures suggesting that the increase may be due to some factor in the infertile population rather than the treatments themselves.

Assisted reproductive technologies: estimates of their contribution to multiple births and newborn hospital days in the United States

Estimate the contribution of assisted reproductive technology (ART) in the United States to multiple gestation births and newborn hospital days. Analysis of successful ART conceptions occurring during 1990 to 1991 compared with vital statistics. Newborn hospital days are estimated from the 1990 National Hospital Discharge Survey. The American Fertility Society and the Society for Assisted Reproductive Technology registry. Infants delivered from ART. Assisted reproductive technology. Number of multiple gestation infants and newborn hospital days. Approximately 12,327 live-born infants were delivered from ART conceptions during 1990 to 1991, representing 22.2% of all live-born triplet, 17.3% of quadruplet, and 11.4% of quintuplet infants born in the United States. The number of newborn hospital days attributed to ART infants was 87,135 days. Between the periods 1972 through 1974 and 1990 through 1991, the rate of triplet and higher order multiple gestation infants per 100,000 white live births increased by 191%, with 38% due to ART conceptions and 30% to increased childbearing among older women. Assisted reproductive technology contributed 22% of U.S. triplet and higher order multiple births during 1990 to 1991.