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Test-Tube Babies: Are They Healthy?

Birth defects and low birth weight are more prevalent in children conceived with assisted reproductive technology.

Pediatricians are caring for increasing numbers of children conceived by assisted reproductive technology (ART). Two groups of investigators evaluated whether ART increased risk for birth defects or low birth weight.

Australian investigators examined the prevalence of major birth defects in infants conceived naturally and those conceived with intracytoplasmic sperm injection (ICSJ) or in vitro fertilization (IVF). Major birth defects (including cleft lip or palate and tracheoesophageal fistula) were diagnosed by 1 year of age in 8.6% of infants conceived with ICSJ (26 of 301); 9.0% of infants conceived with IVF (75 of 837); and 4.2% of naturally conceived infants (168 of 4000). After controlling for confounding variables, the researchers found the risk for a major birth defect to be twice as high in children conceived by ART as in children conceived naturally.

In another study, investigators from the Centers for Disease Control and Prevention compared risk for low birth weight in 42,463 term infants conceived by ART and born in 1996 and 1997 with 3,389,098 naturally conceived, term infants born in 1997. Among singleton infants, those conceived with ART had a risk for LBW 2.6 times the risk in the general population. In twin births, ART was not associated with increased risk for LBW.

Comment: These studies have both clinical and public health implications. Clinicians caring for infants conceived by ART should be aware that the risk for major birth defects is substantial -- almost 10%. ART does not appear to increase the likelihood of LBW in multiple gestations, but does increase the risk in singleton births. An editorialist notes that if infertility itself increases the risks for LBW and birth defects, then providing ART to couples who are not really infertile will involve stress, time, and money but will not result in greater occurrence of these conditions. If, on the other hand, ART causes these complications, then its use in couples who are not infertile will result in avoidable excess risk.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine April 1, 2002

Citation(s):

Hansen M et al. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med 2002 Mar 7; 346:725-30.

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Schieve LA et al. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med 2002 Mar 7; 346:731-7.

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Mitchell AA. Infertility treatment -- More risks and challenges. N Engl J Med 2002 Mar 7; 346:769-70.

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