Assisted reproductive technology may raise risk of congenital anomalies in infants

Children conceived with assisted reproductive technology (ART) appear to be at slightly increased risk for developing genitourinary abnormalities, according to a study.

A total of 851,984 infants (828,099 singletons and 23,885 plural children) delivered between 2009 and 2017 were included in this propensity score-weighted population-based cohort study in Australia. The authors compared the adjusted risk difference (aRD) in congenital anomalies among infants conceived through fertility treatment with two naturally conceived control groups.

Overall, the incidence of congenital anomalies was 459 per 10,000 singleton births and 757 per 10,000 plural births. ART-conceived singleton infants (n=31,256) had a higher risk of major genitourinary abnormalities (aRD, 19.0 cases per 10,000 births, 95 percent confidence interval [CI], 2.3‒35.6) than naturally conceived-fertile singleton control infants (n=747,018).

This risk persisted (aRD, 22 cases per 10,000 births, 95 percent CI, 4.6‒39.3) when compared with naturally conceived-infertile singleton control infants (n=36,251) after accounting for parental infertility. Such finding indicated that ART remained an independent risk, according to the authors.

In addition, intracytoplasmic sperm injection (ICSI) in couples without male infertility resulted in a higher risk of major genitourinary abnormalities (aRD, 47.8 cases per 10,000 singleton births, 95 percent CI, 12.6‒83.1) after accounting for parental infertility.

A trend towards an increased risk for congenital anomalies was also seen following fresh embryo transfer, but estimates were imprecise and inconsistent. Notably, no increased risk for congenital anomalies were observed among infants conceived with ovulation induction and intrauterine insemination (n=13,574).

“Patients should be counselled on the small increased risk for genitourinary abnormalities after ART, particularly after ICSI, which should be avoided in couples without problems of male infertility,” the authors said.