Refuting the Association Between Assisted Reproductive Technology and Autism Spectrum Disorder: A Case-Control Study

In the past 2 decades, the rates of autism spectrum disorder and assisted reproductive technology have increased significantly, leading to a controversial discussion regarding their association. This study investigates the possible association between assisted reproductive technology and autism spectrum disorder using a case-control design, comparing 319 children diagnosed with autism spectrum disorder from 2013 to 2020 with 319 age-matched typically developing children followed prospectively from birth. The differences between assisted reproductive technology and spontaneous conception were analyzed between groups, adjusting for gender, types of assisted reproductive technology, and severity of autism. As expected, there is male predisposition in the autism group. The rate of assisted reproductive technology use in the autism spectrum disorder group (8.5%) was not significantly different from that in typically developing children (9.4%). Within the autism spectrum disorder group, the conception via assisted reproductive technology did not substantially influence gender distribution or severity of autism in comparison to spontaneous conception. After adjusting for potential confounders, the odds ratio for assisted reproductive technology treatment was not statistically significant (adjusted odds ratio [aOR] = 0.537, 95% confidence interval [CI] 0.110-3.383). Similarly, no significant association was found for hormonal treatment (aOR = 0.632, 95% CI 0.326-1.223) or for in vitro fertilization pregnancies (aOR = 0.689, 95% CI 0.180-2.628). In conclusion, assisted reproductive technology was not found to be more common in children with autism spectrum disorder as compared to typically developing children and did not correlate with gender or autism severity within the autism spectrum disorder group. Our findings effectively counter the concerns regarding a significant association between assisted reproductive technology and autism and provide reassurance.