Birth defects and assisted reproductive technologies (ART): A reproductive endocrinologist's review and perspective.
Questions have been raised regarding birth defect rates with IVF, especially with intracytoplasmic sperm injection (ICSI). This is an extremely complex issue because numerous factors confound detection and reporting of birth defects.
However, while acknowledging significant limitations of the currently available data, the authors present them with the objective of improving our current and future knowledge of ART outcomes. Large national and international registries in the US and Europe have not demonstrated differences in birth defect rates for children born as a result of IVF or ICSI. Smaller studies have also shown no measurable difference in birth defect rates in ART babies. Recently, however, controlled studies in prestigious journals have reported an approximate increased risk of approximately 2 for birth defects in children born as a result of ICSI and IVF. Additionally, increased risk of hypospadius and other gene-related diseases following ICSI, and of Beckwith-Wiedemann syndrome, Angelman syndrome and retinoblastoma following ART have appeared in the literature. Limitations of study methodology complicate evaluation of all studies. Controversy surrounds these studies, with some focusing concern on potential hazards of ART, while others emphasize the small absolute risks and generally healthy outcomes in over 1 million ART babies worldwide. Additional studies are necessary so that appropriate counseling, intervention and improved technology can reduce risks of birth defects following ART. Future studies should include not only IVF and ICSI offspring, but also case-controls from non-ART infertile populations and from populations with normal fertility.