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Fertility Treatment Studies May Alarm — Make Sure You Understand the Facts
by Leigh Ann Woodruff, May 7, 2012
During the past few weeks, several studies have come out with alarming headlines about fertility treatment, with the most recent linking a type of fertility treatment to birth defect risk in the resulting children. Other recent studies have linked fertility treatment to childhood leukemia and circulatory problems in children.
If you are a fertility treatment patient, try to put the studies into perspective. There are many factors that can increase the risk of a certain condition, but the overall risk may remain relatively low.
Fertility Treatment and Birth Defects Study
Researchers have known for a while that babies born via assisted reproductive technology (ART) are more likely to have birth defects. A recent study, published in the New England Journal of Medicine, suggests that two things play a role in this: certain fertility treatments and infertility itself.
“This study confirms what has been known for quite some time: Patients who need medical assistance to conceive have a somewhat higher risk of having children with birth defects than parents able to conceive on their own," says Linda Giudice, MD, PhD, a fertility doctor with UCSF Center for Reproductive Health and president-elect of the American Society for Reproductive Medicine (ASRM). "Patients considering medically assisted conception have been, and should continue to be, counseled on those risks prior to undergoing any treatment.”
Australian researchers looked at the records of nearly 303,000 babies conceived naturally and 6,163 conceived with help in Australia from 1986 through 2002, along with records on birth defects detected by age 5. The investigators counted heart, spinal or urinary tract defects, limb abnormalities and problems such as cleft palate or lip, and they looked at birth defect rates according to type of fertility treatment, including in vitro fertilization (IVF), IVF with intracytoplasmic sperm injection (ICSI) and ovulation induction with clomiphene citrate (Clomid).
After adjusting for parental factors such as smoking, the researchers found:
- Babies born from simple in vitro fertilization (IVF) — in which sperm and an egg were mixed together in a lab dish — had no greater rate of birth defects.
- Babies born from IVF with ICSI — a lab technique in which a single sperm is injected into an egg — had a higher rate of birth defects.
- A history of infertility, either with or without assisted conception, was also associated significantly associated with birth defects.
- Freezing of embryos was associated with a reduced risk of birth defects, particularly with ICSI.
- There was a tripling in risk of birth defects in women using clomiphene citrate — unsupervised — for ovulation induction.
"The unadjusted risk of any birth defect in pregnancies involving assisted conception was 8.3 percent (513 defects), compared with 5.8 percent for pregnancies not involving assisted conception (17,546 defects)," says lead author of the study, Associate Professor Michael Davies from the University of Adelaide's Robinson Institute and School of Paediatrics and Reproductive Health."The risk of birth defects for IVF was 7.2 percent (165 birth defects); and the rate for ICSI was higher at 9.9 percent (139 defects).
"A history of infertility, either with or without assisted conception, was also significantly associated with birth defects," he continues. "While factors associated with the causes of infertility explained the excess risk associated with IVF, the increased risk for a number of other treatments could not readily be explained by patient factors. ICSI, for instance, had a 57 percent increase in the odds of major defect, although the absolute size of the risk remained relatively small."
Should Your Be Concerned?
Overall, the rate of birth defects is about 6 percent with unassisted conception, 7 percent with IVF and 10 percent with ICSI.
When a new study comes out, ignore the alarming headlines, read the reports, do your research and ask questions of your fertility doctor. Find out the risks and benefits of each particular aspect of your treatment and find out whether you need that particular treatment.
On this recent study, Glenn Schattman, M.D., a fertility doctor at The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine at Weill Cornell Medical Center and President of the Society for Assisted Reproductive Technology (SART), says, “It is important to note that women with a history of infertility who did not undergo ART treatments also had a higher increase of having children with birth defects. This combined with the finding that those using ICSI also had slightly elevated risks of birth defects suggest that the underlying problem that led them to seek medical assistance in the first place is likely contributing to the elevated risk of birth defects in their children.
"Some results in this study are reassuring for patients," he continues. "In cycles not including ICSI, the adjusted odds ratio for IVF conceived children did NOT show a significant difference in birth defects, and children born following embryo freezing had no higher risk of birth defects than naturally conceived children. These are interesting and important findings and we will need much more research to allow us to help patients overcome their infertility with treatments that are as safe as possible for them and the children born from the treatments.”