Takeaways
- Offspring of individuals with infertility, particularly those who underwent fertility treatments like ovulation induction (OI), intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI), have a slightly elevated risk of autism spectrum disorder (ASD).
- ASD may manifest in children as young as 18 months, emphasizing the importance of understanding and identifying risk factors during the perinatal period, especially considering that infertility affects 1 in 6 couples.
- Approximately 10 million infants worldwide have been delivered through fertility treatments. These include various assisted reproductive technologies like OI, IUI, IVF, and ICSI, and the study highlights the need for further research on their potential associations with ASD.
- Maternal metabolic and inflammatory factors, along with epigenetic changes, are linked to ASD risk in offspring. Epigenetic changes have been observed in children born to women with infertility and those born through ICSI.
- The study, conducted in Ontario, Canada, involved a retrospective, population-based analysis. It suggests that efforts should be made to reduce multifetal pregnancies resulting from OI, IUI, and IVF.
Offspring of individuals with infertility are at a slightly increased risk of autism spectrum disorder (ASD), according to a recent study published in JAMA Network Open.
ASD may present in children aged as young as 18 months, making it vital to understand risk factors in the perinatal period. This includes infertility, which is experienced by 1 in 6 couples.
Approximately 10 million infants worldwide have been delivered using fertility treatments such as ovulation induction (OI), intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI).
Maternal metabolic and inflammatory factors and offspring epigenetic changes are associated with ASD risk in offspring, and epigenetic changes have been recorded in children of women with infertility, as well as those born by ICSI. While initial studies have not associated OI, IUI, IVF, or ICSI use with ASD risk, there is little data on the association between conception method and ASD.
To determine the association between infertility and fertility treatment with ASD risk, investigators conducted a retrospective, population-based study using health data from Ontario, Canada. Participants included singleton and multiple hospital live births at 24 weeks’ gestation or later between April 1, 2006, and March 31, 2018.
Included mothers were aged 18 to 55 years, and exclusion criteria included surrogate pregnancy, pregnancy ending in induced abortion, child death before 18 months of age, and incomplete records. Exposures included unassisted conception, subfertility, OI or IUI, and IVF or ICSI.
ASD diagnosis starting at 18 months was the primary outcome of the analysis, based on 2 or more outpatient diagnoses or 1 or more hospitalization diagnoses. Covariates included parity, maternal age, rurality, income quintile, smoking, immigration status, alcohol use, illicit substance use, obesity, prepregnancy diabetes or chronic hypertension, maternal ASD history, and mental illness within 2 years before conception and up to 19 months postpartum.
There were 1,370,152 children included in the final analysis, of whom 86.5% were from pregnancies with unassisted conception, 10.3% in individuals with subfertility, 1.5% following OI or IUI, and 1.7% following IVF or ICSI. Patients with subfertility or fertility treatment were more often older, nulliparous, residing in a higher-income area, and had prepregnancy diabetes and chronic hypertension.
Follow-up occurred for a median 8.1 years, during which 1.6% of children received an ASD diagnosis. ASD was observed in 1.6% of children born to individuals with unassisted conception, 2% to individuals with subfertility, 2% following OI or IUI, and 1.9% following IVF or ICSI.
An incidence rate for ASD of 1.93 was reported among the unassisted conception group, compared to 2.49 in the subfertility group, 2.72 in the after OI or IUI group, and 2.71 in the after IVF or ICSI group.Similar results were found in a model restricted to singleton births.
These results indicated a slight increase in ASD risk among offspring of individuals with infertility. Investigators recommended efforts to reduce multifetal pregnancy following OI or IUI and IVF, as well as focus care pregnancy plans for individuals with subfertility and fertility treatment.
Reference:
Velez MP, Dayan N, Shellenberger J, et al. Infertility and risk of autism spectrum disorder in children. JAMA Netw Open. 2023;6(11):e2343954. doi:10.1001/jamanetworkopen.2023.43954
This article was initially published by our sister publication, Contemporary OB/GYN.
