Image: PD Intracytoplasmic sperm injection

1. Children born after any IVF procedure had increased risk of mental retardation compared to spontaneous conception.

2. Highest rates of autism and mental retardation were associated with intracytoplasmic sperm injection using surgically extracted sperm with fresh embryos.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Over the last few decades in vitro fertilization (IVF) has experienced a remarkable increase in popularity and efficacy. IVF treatments give couples the opportunity to conceive a child despite male or female infertility. IVF is usually used in the absence of male infertility while intracytoplasmic sperm injection (ICSI) is used to treat male infertility. Commonly known complications include preterm birth and low birth weight. While studies have investigated the association of IVF treatments with neurologic disorders such as cerebral palsy, neurodevelopmental conditions have not been sufficiently documented. Consequently, in the largest prospective study of its kind, the authors of this study analyzed the risk of mental retardation and autistic disorder in children conceived via IVF.

In a study following over two million children in Sweden, the authors were able to reveal the presence of a small, but statistically significant, risk of mental retardation in children following the use of an IVF procedure. Importantly, this risk was shown to be higher when part of multiple births or preterm births. While the largest study of its kind, it is not without error. For one, the authors used a narrow diagnosis of autism while excluding most forms of autism spectrum disorders. Further, the number of children were relatively small in subgroups such as those utilizing surgically extracted sperm. Yet, the number of births using IVF procedures will continue to increase as the technology improves. Additional long-term studies of multiple births and the effects of hormones and embryo culture will represent the future of IVF research. With this will come a better understanding of the neurodevelopmental consequences and hopefully a lowered risk of autism and mental retardation associated with IVF.

Click to read the study published today in JAMA

Click to read an accompanying editorial in JAMA

Relevant Reading: Risk of autism spectrum disorders in children born after assisted conception: a population-based follow-up study

In Depth [prospective cohort]: The authors followed the Swedish national registers which included 2,541,125 live births including 30,959 born using an IVF procedures from January 1, 1982 to December 31, 2007. Children were followed from age 1.5 to death, or until emigration from Sweden, onset of disease, the age of 28 years, or December 2009. It was found that children born after any IVF procedure had increased risk of mental retardation compared to spontaneous conception (RR, 1.18 [95% CI, 1.01-1.36]; 46.3 vs 39.8 per 100,000 person-years). Further, parents had an increased risk of having children with autistic disorders after utilizing ICSI using surgically extracted sperm with fresh embryos compared to those born after IVF without ICSI (RR, 4.60 [95% CI, 2.14-9.88]. The association of surgically extracted sperm with autistic disorder (RR, 8.06) and mental retardation (RR, 3.31) were further increased by preterm births. Notably, autism and mental retardation rates were independent of age and gender of the child.

By John Prendergass and Brittany Hasty

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