COMMENTARY

Are Babies Born via ART More Likely to Have Birth Defects?

Peter Kovacs, MD, PhD

Disclosures

June 17, 2016

Viewpoint

Congenital anomalies cannot always be linked to a specific causal factor, but genetic, lifestyle, medical, environmental, infectious, and toxic factors all could play a role. Early reports found no increased risk, but reports from the late 90s or after 2000 consistently have shown a roughly 30% increase.[2,3,4,5] Most studies have compared malformation rates in fertile women to rates in infertile women. Besides fertility status, there are other important differences that can be seen. Infertile women tend to be older, they are more likely to be affected by medical or endocrine problems, and they are more likely to be obese. However, women who undergo ART treatments tend to also be better educated and less likely to have toxic habits. These factors all could influence the overall risk, so they need to be controlled for during the analysis.

Children born to infertile women may undergo a more detailed neonatal assessment; and, therefore, anomalies that otherwise would be missed could be picked up. An infertile couple may elect to continue a pregnancy (conceived after many years of trying) that is affected by a non-life-threatening malformation.

There are more multifetal pregnancies following ART treatments.[1] Some of these will spontaneously reduce (vanishing twin), while others may result in preterm delivery. These issues will also affect the frequency of anomalies.

It also cannot be ruled out that the use of gonadotropin stimulation, the high steroid levels during treatment, the in vitro gamete/embryo handling, and the use of culture media may induce changes in an early embryo that will increase the risk for malformations.

It's also important to consider the well-known differences among fertile and infertile women and the impact of these differences on the anomaly rate. Several reports showed an increased risk for birth defects in children conceived spontaneously in otherwise subfertile women.[4,5]

Infertile couples need to be informed that there is an approximately 30% relative increase in the risk for congenital malformations over the general population risk of around 3%-4%.[2] If an anomaly is found, the decision about the fate of the pregnancy can only be made with the involvement of the parents, geneticist, neonatologist, and pediatric surgeon.

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