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Q: I have fraternal twins who are now just over age 5. They were born with the help of a fertility treatment called intracytoplasmic sperm injection. Both have developmental delays. For example, they are still in diapers and don’t speak except for a few words. One child was also born with a cleft palate. Both arrived prematurely via C-section and weighed around 5 pounds each. Has there been any research that links birth defects or developmental delays with fertility treatments?
A: You’re not the only one wondering about the well-being of babies conceived with the help of in vitro fertilization (IVF) or other forms of assisted reproductive technology (ART). The American Academy of Pediatrics and the American Society for Reproductive Medicine co-sponsored a panel to review published studies that have reported on malformations and genetic anomalies, cancer, psycho-social and developmental outcomes, and health status beyond one year for ART children.
The panel, chaired by Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University, announced its findings late last year.
“After evaluating all of the studies thus far, what we found was basically reassuring,” says Hudson.
Sifting through hundreds of studies and looking at how they were conducted and how the conclusions were drawn, the panel ultimately found no substantial link between ART and developmental delays, and they found little evidence that ART was responsible for most malformations or health concerns.
However, there are certain extremely rare genetic conditions, such as Angelman syndrome and Beckwith-Wiedemann syndrome, that do seem to be more common -- yet are still very rare -- in ART children. And the panel is currently reevaluating the data on hypospadia, a condition where the urethra opening doesn’t wind up where it’s supposed to be on the end of the penis. Some researchers still believe hypospadia may be more prevalent in ART boys.
If you’re looking for an explanation, though, the fact that your children were lower birth-weight multiples may provide some of it. Of course, ART results in far more multiples than would otherwise be conceived. All multiples -- conceived traditionally or with ART -- are at increased risk for premature delivery and low birth weight, conditions that can lead to further complications and developmental delays, says Hudson.
“Roughly 25 percent [of ART] offspring are twins or triplets. Ninety percent of the triplets, in fact, are due to in vitro or other fertility treatments. That’s a problem,” says Dr. Arnold Strauss, another member of the panel evaluating the studies.
The panel is in the process of making recommendations to the medical community, and Strauss says the most important recommendation is that the rate of multiples needs to be reduced.
Fertility specialists often implant several embryos in a woman's womb to increase the chances of success and lower the costs. However, that also increases the odds of multiples -- and possible complications.
“I don’t think fertility doctors shouldn’t be implanting more than three embryos at once,” he says.
All of this is valuable information for couples considering ART. But for parents of children who are already here, Hudson and Strauss have a different message. “Birth defects or developmental problems are usually not the fault of the parent or because of anything they did,” says Hudson. That includes fertility treatment.
Furthermore, says Strauss, who is chairman of pediatrics at Vanderbilt University Medical Center in Nashville, Tenn., the reasons behind the problems may be intriguing but your children need something else: help.
“The quicker and the more aggressively any child with developmental delays is involved in special education that addresses his specific needs, the better the possible outcome,” says Strauss.
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