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Assisted reproduction related to the risk of intellectual disabilities in children


– Parents using reproductive technologies, such as in vitro fertilization (IVF), may have more chances to have children with intellectual disabilities than those who conceive without help, suggests an Australian study.

The researchers examined 2876 children with ART and 207,751 children born without ART in Western Australia between 1994 and 2002. Only 3551 of these children were diagnosed with intellectual disabilities after being followed for at least eight years.

Children born with ART were 58% more likely to have intellectual disabilities aged 8 years or older. With ART, children were also more likely to have serious deficits.

Overall, however, intellectual disability rates were still low. Of all children born during the study period, 3551 diagnosed with intellectual disabilities represent approximately 17 children per 1,000 live births. Among children with ART, the rate was 20 to 1,000.

"The vast majority of ART children are born healthy and will not be diagnosed with an intellectual disability," said lead author Michele Hansen of the Telethon Kids Institute and the University of West Australia in Perth.

A type of IVF known as intracytoplasmic sperm injection (ICSI) was responsible for most of the increased risk of intellectual disabilities seen in ART. Unlike traditional IVF, when sperm and egg mix together natural "in a vessel, ICSI involves sperm injection into the egg and is often used in cases of male infertility or low sperm count.

Children born with ICSI have more than twice the risk of intellectual disabilities of children born without ART, say researchers in Pediatrics.

"Until we know more about the risks associated with the ICSI technique per se than the male factor subfertility and the older age of parents using this technique, clinics may consider limiting ICSI use to those couples that are unlikely to be able to conceive without it – that is, those with severe infertility of the male factor, "Hansen said by email.

Children born after ICSI were more likely to have a known genetic condition than IVF or non ART children found the study. While 28 percent of ICSI children had a genetic disorder, only 12 to 13 percent of the other children did.

Down syndrome was the most common cause of intellectual disability, accounting for 10% of ART cases of intellectual disability and 5% of non-ART cases.

The cause of most intellectual deficits was unknown for 72% of the ART group and 82% of the non-ART group.

Among children without an identified cause for intellectual disability, ART children were more likely to be underweight, multiple, who were exposed to complications of pregnancy or diagnosed with cerebral palsy.

The study was not designed to prove whether or how ART could contribute to intellectual disability in children. Another limitation is that reproductive technology has changed in the years since the children of the study were born, physicians encouraging them more and more on their own, rather than on multiple births, to minimize complications.

However, it is unclear whether ART or fertility problems that cause couples to conceive in this way could ultimately be responsible for intellectual disabilities, "said Judy Stern, professor of obstetrics and gynecology at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.

"Parents performing ART do this because they have exhausted other options to have a family," Stern said, who was not involved in the study by email. Patients should remember that the magnitude of the anomalies demonstrated in this work is low.

Women who are considering ICSI still want to ask their doctor if this is the only option if they can make traditional IVF in place, said Logan Spector, a researcher at the University of Minnesota in Minneapolis, who was not involved in the study .

Physicians should limit the use of ICSI when possible, Spector said.

SOURCE: Pediatrics, online, November 15, 2018.

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