The long term health impact on the children conceived from infertility treatment is the ultimate 64 million dollar question—at least

for those whose only chance for biological kids is through the miracle of modern fertility medicine. Not only is it a huge unknown and source of ongoing worry, it’s also one of those infuriating chicken-or-egg type questions: is it fertility treatment that increases the risk of birth defects and disorders, or is it the underlying infertility itself, or parental age, or any host of other things you don’t have control over? And if you don’t have control, and if this is your only way to have a child, then what’s the point of worrying? Humm, all questions we pondered before the Creating a Family show this week on the Health Effects of Fertility Treatment on Children.

Research moves our knowledge forward in fits and starts– incrementally, with a few red herrings thrown in along the way. That may drive those of us who are bottom-line oriented crazy, but it is the nature of untangling the unknown. Research into the possible negative health effects on children conceived from in vitro fertilization, intracytoplasmic sperm injection (ICSI), or even just Clomid, is particularly difficult to design. We are looking for many potential health issues and many potential causes:

Potential Negative Health Effects:

  • Birth defects from minor to life threatening (heart, eyes, reproductive organs and urinary systems, muscular skeletal) 
  • Behavioral/Emotional (autism, attention deficit disorder (ADHD), depression)
  • Others (diabetes, obesity, growth…)

Potential Causes:

  • Infertility treatment procedures (IVF, ICSI, embryo freezing (day 3, day 5), Pre-Implantation Genetic Diagnosis (PGD), etc.
  • Older treatments vs. new techniques and protocols
  • Fertility Medications (clomiphene citrate, gonadotropins, etc.)
  • Maternal or paternal age
  • Premature birth
  • Multiple birth
  • Socio-economics
  • Parental infertility

With this much to untangle, we need studies that look at a large number of children, and since many of the possible diseases/disorders aren’t apparent until the child is older, we need long term studies. Large and long research is expensive, and by its very nature takes a long time. Some really good research is now beginning to come in.

The good news is that it seems pretty clear that the vast majority of kids conceived through infertility treatment are just fine (actually perfect, at least according to their parents). It is also becoming clearer that, even controlling for the various compounding factors such as maternal age, infertility, premature birth, etc., the kids are at an increased risk for certain birth defects and disorders, although the overall percentages are still quite low. And that, my friends, is exactly what we talked about on this week’s show. Dr. Thomas Molinaro, a reproductive endocrinologist at Reproductive Medicine Associates New Jersey, professor, epidemiologist, and researcher struck just the right balance of factual, but not sensational. I think you’ll find it to be a breath of fresh air.

 


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What We Talked About:

  • While this show focused on the possible health ramifications of children conceived from fertility treatment, it is important to keep things in perspective and realize that the vast majority of children are not impacted.
  • Research is beginning to come in to help us untangle that chicken-or-egg question we have going on: do infertility treatments raise the risk of birth defects, or is the risk linked to the parent’s infertility itself? 
  • We need to focus on not just birth defects but to other health impacts—autism, neurodevelopmental disorder, sensory processing disorders, ADHD, autism, cerebral palsy, etc. 
  • Does maternal use of Clomid (clomiphene citrate) increase the risk of birth defects in the children?
  • Do the ovulatory stimulating medications, such as Gonadotropins, increase the risk of birth defects or other health issues in the children?
  • Does maternal use of other fertility medications have health impacts on the babies conceived?
  • When you take out things such as prematurity due to multiples, complications due to advanced maternal age, and other confounders, is there still a long term health impact? 
  • How do you know if any increased risk in birth defects is associated with the fertility drugs, the fertility treatment used (IVF, ICSI, IUI), the parent’s infertility itself, maternal and paternal age, or something else?
  • Have any studies been done on the effect of long term (>10 years) freezing of embryos?
  • What should parents and pediatricians be on the lookout for with children who were conveived through some form of infertility treatment.
  • What are the health risks to the child of being born to an older mother?
  • What are the health risks to the child of being born premature?
  • What are the health risks to the child of being born a twin?
  • Are the health risk to the child greater if the child is born from a frozen embryo?
  • Are the health risks to the child less if born from an embryo created from donor egg?
  • What are the health risks to the infant conceived with ICSI?
  • Are the children of infertile couples more likely to have birth defects or other disorders?
  • Does infertility treatment increase the risk of cancer in the children?
  • Have researchers been able to find a difference in the behavior of children conceived through infertility treatment?
  • Or all births from infertility treatment at increased risk for premature birth?
  • Are children born from infertility treatment at an increased risk for autism or autism spectrum disorders?
  • Are children born from infertility treatment at an increased risk for attention deficit disorder, (ADHD)?
  • Are children born from infertility treatment at an increased risk to be infertile when they reach adulthood?

 

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