Assisted Reproductive Technologies and Offspring's School Grades by Maternal Education

Children conceived through assisted reproductive technologies (ART) often achieve higher school grades than spontaneously conceived peers in unadjusted analyses, a pattern largely attributed to the socio-economic advantage of parents who use ART. However, as ART is increasingly utilised by less advantaged groups, it is important to understand how ART-conceived children fare when their parents have lower levels of education.

The objective of this study is to examine whether the association between conception through assisted reproductive technologies and school grades at age 16 differs by maternal education.

We conducted a population-based cohort study of all live-born children in Norway from 1985 to 2002 who completed compulsory schooling (n = 929,017), using nationwide register data. The exposure was conception through ART (1.0%), and the outcome was the standardised grade point average (GPA) at age 16. Analyses were stratified by maternal education (primary/secondary vs. tertiary). Using linear regression models, we estimated differences in GPA between ART- and spontaneously conceived children. We progressively adjusted for child sex, birth cohort, plurality, birth order, maternal age, parental income and family structure.

Among children of lower-educated mothers, mean GPA was higher for ART-conceived than spontaneously conceived children in baseline models (0.17, 95% confidence interval [CI] 0.14, 0.19). Among children of tertiary-educated mothers, the corresponding difference was 0.06 (95% CI 0.03, 0.09). After adjustment, the differences were slightly negative but small in magnitude in both education groups (primary/secondary: -0.18, 95% CI -0.21, -0.16; tertiary: -0.08, 95% CI -0.11, -0.05).

Both ART-conceived children of less- and more-educated mothers appear advantaged in unadjusted analyses. After accounting for parental characteristics, differences were small in both education groups, reflecting socio-demographic selection into treatment within each group. These findings suggest that as ART use expands across more socio-economically diverse populations, it is unlikely to independently improve or worsen children's school performance across educational strata.