Infertility linked to higher birth defect risk

1. Compared to naturally conceived newborns, couples with infertility who conceived by assisted reproductive technologies (ART) were more likely to be born with a non-genetic birth defect.

2. The absolute risk of a non-genetic birth defect among infertile couples who conceived via ART treatments was very low.

Evidence Rating Level: 2 (Good)

Study Rundown: As assisted reproductive technologies (ART) treatments have developed, treatments like in vitro fertilization (IVF) have become more accessible to a wider population. Accordingly, the number of women using fertility treatments to conceive has increased such that in 2012, roughly 1.5 percent of all liveborn infants in the United States were conceived using some method of ART. While ART is considered safe, a number of large studies suggest there may be an increase in birth defects associated with its use. However, it is difficult to identify risk of birth defects associated with ART treatments in and of themselves, and not associated with the baseline higher rate of defects in the infertile population in general. The actual magnitude of risk of birth defects in infertile couples remains uncertain, however, as these couples by definition are unable to conceive. Researchers in this study used population based data from three states to compare the prevalence of birth defects among pregnancies conceived naturally compared to those conceived via ART treatments.

Compared to naturally conceived newborns, those conceived by infertile couples using ART treatments were more likely to be diagnosed with a non-genetic birth defect. Strengths of this study included a large, population-based cohort. A major limitation was that the analyses did not account for a baseline higher incidence of birth defects among infertile couples. Additional limitations include assessment of outcomes only from liveborn infants, which may lead to an underestimation of total birth defects. Future prospective studies comparing the incidence of birth defects among infertile couples who conceived spontaneously, with ovulation induction, and via various ART procedures are warranted.

Click to read the study in JAMA Pediatrics

Relevant Reading: Reproductive technologies and the risk of birth defects

In-Depth [retrospective cohort study]: Using linked ART surveillance, birth certificates, and birth defects registries for Florida, Massachusetts, and Michigan, researchers compared the prevalence of birth defects between infants conceived naturally (n = 4 553 115) and using ART (n = 64 861, 1.4%) from 2000-2010.

Close to 0.59 percent (n = 389) of infants conceived through ART had a non-genetic birth defect compared to 0.48 percent (n = 22 036) of those conceived naturally (aRR: 1.28, 95% CI: 1.15-1.42). Among ART births, the risk of birth defects was greater in women with ovulation disorders (aRR: 1.53; 95% CI: 1.13-2.06) and those who conceived using assisted hatching (aRR: 1.55; 95% CI: 1.10-2.19).

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