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Reproductive technologies and the risk of birth defects
Michael J Davies1, Vivienne M Moore, Kristyn J Willson
1Robinson Institute, University of Adelaide, Adelaide, SA, Australia. michael.davies@adelaide.edu.au
The New England Journal of Medicine
|May 8, 2012
Summary
Birth defect risks associated with assisted reproductive technology (ART) vary. While in vitro fertilization (IVF) risks diminished with parental factor adjustment, intracytoptoplasmic sperm injection (ICSI) risks persisted, suggesting potential confounding factors.
Area of Science:
- Reproductive Medicine
- Pediatric Health
- Genetics and Genomics
Background:
- The contribution of parental factors to birth defects following infertility treatments remains unclear.
- Investigating the link between assisted reproductive technology (ART) and congenital anomalies is crucial for understanding reproductive health outcomes.
Purpose of the Study:
- To determine the association between assisted reproductive technology (ART) and the risk of birth defects.
- To differentiate the risks associated with specific ART methods like in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
- To assess the influence of underlying parental factors on the observed risks.
Main Methods:
- A population-based cohort study in South Australia linked ART treatment data with birth and defect registries.
- Compared birth defect risks across pregnancies conceived via ART, spontaneous conception in women with prior ART, infertility without ART, and women with no infertility history.
- Birth defects were tracked up to the child's fifth birthday, including terminations for defects.
Main Results:
- The overall risk of birth defects was higher in ART-conceived pregnancies (8.3%) compared to non-ART (5.8%), with an adjusted odds ratio of 1.28.
- In vitro fertilization (IVF) showed an initial increased risk (OR 1.26), which became non-significant after adjusting for parental factors (OR 1.07).
- Intracytoplasmic sperm injection (ICSI) demonstrated a persistent increased risk (OR 1.77 unadjusted, 1.57 adjusted). A history of infertility itself was also linked to higher defect risks.
Conclusions:
- The elevated risk of birth defects linked to IVF appears to be explained by parental factors.
- A significant association between ICSI and birth defects persists even after multivariate adjustment, though residual confounding is possible.
- Parental characteristics play a significant role in the occurrence of birth defects among infertile populations.
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