Assisted Reproductive Technology May Increase the Risk of Birth Defects
November 22, 2008
Analysis of a recent population-based, multicenter, case-control study carried out in the US reported a 2-4 fold increased risk of birth defects in infants conceived as a result of assisted reproductive technologies (ARTs), such as in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) when compared to natural conception. The study results have been published in the recent online edition of the journal, Human Reproduction.
Jennita Reefhuis, an epidemiologist at the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), USA, and coworkers, evaluated the data from National Birth Defects Prevention Study (NBDPS), in order to examine the association between ART and birth defects. The study interrogated mothers of fetuses or live-born infants with (case infants) and without a major birth defect (control infants), conceived naturally or through ART, during October 1997-December 2003. Adjustments for cofounders such as maternal age, maternal race/ethnicity, smoking and parity were made using multiple logistic regression. The adoption of ART was reported in 1.1% of all control mothers and 4.5% of control mothers aged 35 years and above. Among singleton births, the researchers observed a crucial association between ART and the occurrence of increased birth defects including cleft lip with or without cleft palate (aOR=2.4), septal heart defects (aOR=2.1), esophageal atresia (aOR=4.5), and anorectal atresia (aOR=3.7), when compared to natural birth. However, the study couldn’t find any such association between ART and congenital abnormalities among multiple births.
Earlier, Shevell, et al. (Obstetrics and Gynecology, 2007) conducted a large, multicenter study to evaluate the association between ART and increase in fetal malformations, chromosomal abnormalities or adverse pregnancy outcomes. The researchers analyzed a total of 36,062 pregnant women, of whom 95.1% conceived spontaneously, and 1.5% and 3.4% of them adopted IVF and ovulation induction, respectively. The study findings showed that ovulation induction was associated with a statistically significant increase in fetal loss after 24 weeks, placental abruption and gestational diabetes. It was also noted that the use of IVF was linked to a considerable increase in gestational hypertension, placenta previa, placental abruption, preeclampsia, and risk of cesarean delivery. However, in comparison to spontaneous conception, ART was not found to be associated with the incidence of fetal growth restriction, fetal anomalies or aneuploidy.
The use of ART to treat infertility has increased substantially since its introduction in 1981 in US. In 2005, the country saw more than 134,000 ART procedures being performed, with over 52,000 live-born infants delivered using this technology, which represents >1% of the total births.
With the recent studies resulting in contradictory outcomes, further epidemiologic research is imperative in order to precisely determine the etiology and extent of increased risks of congenital abnormalities associated with ART.
References
1. Reefhuis J, Honein MA, Schieve LA, et al. Assisted reproductive technology and major structural birth defects in the United States. Hum Reprod. 2008 Nov 16. [Epub ahead of print]
2. Shevell T, Malone FD, Vidaver J, et al. Assisted reproductive technology and pregnancy outcome. Obstet Gynecol. 2005 Nov;106(5 Pt 1):1039-45.
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2 Responses to “Assisted Reproductive Technology May Increase the Risk of Birth Defects”
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“In the US, 1 in every 950 babies is born with a cleft lip with or without cleft palate. The study showed that using ART doubled this risk to around 1 in every 425.”
As a Fertility Specialist, I always keep patients informed about the facts. Patients should weigh between the risks and the benefits before decide to proceed with any procedure.
However, read between the lines. Statistic data tend to fool the audience by using multiple or percentage.
Take example of the statement above, from the original report, in raw data, how many more baby (ies) has birth defect in a population of 1000 as compared to the control?
Studies also showed that, some of these birth defects probably has something to do with the original causes of infertility ( age, familial trait etc..)
Minh N. Ho, MD
Board Certified in REI
http://www.ivfdoc.com
I have just given birth to a daughter with cleft lip and partial palate who was conceived through IVF. I am 35 and such defect does not run in our familes. I would say that if you read this and are deciding whether or not to have a child using IVF, consider that I am incredibly happy with my perfect daughter.