Science Speaks: No Evidence Supporting Autism Risk in IVF-Generated Offspring
In a recent publication in JAMA Network Open, a significant study explores the intricate connection between infertility, fertility treatments, and the development of Autism Spectrum Disorder (ASD) in children. The research, conducted in Ontario, spans a retrospective cohort from April 2006 to March 2018, incorporating administrative healthcare data from various sources, including the Better Outcomes Registry and Network (BORN) database, hospitalization records, outpatient visits, and emergency department data.
ASD, characterized by abnormal brain development and typically manifesting within 18 months of life, is known to be influenced by a combination of hereditary and environmental factors. Prenatal risk factors include infertility, maternal metabolic and inflammatory variables, and offspring epigenetic alterations. However, prior studies often overlooked the role of infertility and mediating effects in understanding the relationship between ASD and its potential precursors.
The study design involved categorizing conception modes into unaided, subfertility, intrauterine insemination (IUI) or ovulation induction (OI), and intracytoplasmic sperm injections (ICSI) or in vitro fertilization (IVF). Researchers employed multivariable Cox regression modeling, adjusting for various covariates, to determine adjusted hazard ratios (aHRs). Causal mediation analyses were conducted to assess the impact of pregnancy outcomes such as preeclampsia, cesarean birth, multifetal pregnancies, severe neonatal morbidities, and preterm birth on ASD risk.
The results, based on a cohort of 1,370,152 infants, indicated an ASD incidence of 1.9 per 1,000 individual years for those born through unaided conception. Notably, children born to infertile individuals demonstrated a marginally higher ASD risk, irrespective of whether fertility treatments were administered. The study highlighted the significant role of adverse pregnancy outcomes in mediating ASD risk, particularly after ICSI or IVF.
In conclusion, the findings suggest that the underlying factor contributing to the link between parental infertility and ASD in children might be infertility itself rather than fertility treatments. As a result, the study advocates for ongoing efforts to reduce multifetal pregnancies following fertility treatments and emphasizes the need for tailored care plans for subfertile individuals and those undergoing fertility treatment. This comprehensive research provides valuable insights into the complex dynamics of ASD development, paving the way for more targeted and effective care strategies for affected families.
Maria P. Velez, MD, PhD, et al., (2023) Infertility and Risk of Autism Spectrum Disorder in Children, JAMA Network Open., doi:10.1001/jamanetworkopen.2023.43954