Reproductive technologies and the risk of birth defects.
N Engl J Med. 2012 May 10; 366(19):1803-13
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F1000Prime Recommendations, Dissents and Comments for [Davies MJ et al., N Engl J Med 2012, 366(19):1803-13]. In F1000Prime, 20 Jun 2013; F1000Prime.com/715347815
Am J Epidemiol. 2012 Nov 15; 176(10):886-96
Paul Terry and Jiangang Chen 12 Dec 2012
Hum Reprod. 2012 Sep; 27(9):2571-84
Mark Brincat and Jean Calleja-Agius 05 Nov 2012
Alexander Ford 20 Jan 2011
J Med Genet. 2010 Jun; 47(6):371-6
Ibrahim Bildirici 16 Jul 2010
Dariusz J Skarzynski 18 Jan 2013
Alison Pack and Elizabeth Gerard 21 Jul 2011
Background The extent to which birth defects after infertility treatment may be explained by underlying parental factors is uncertain. Methods We linked a census of treatment with assisted reproductive technology in South Australia to a registry of births and terminations with a gestation period of at least 20 weeks or a birth weight of at least 400 g and registries of birth defects (including cerebral palsy and terminations for defects at any gestational period). We compared risks of birth defects (diagnosed before a child's fifth birthday) among pregnancies in women who received treatment with assisted reproductive technology, spontaneous pregnancies (i.e., without assisted conception) in women who had a previous birth with assisted conception, pregnancies in women with a record of infertility but no treatment with assisted reproductive technology, and pregnancies in women with no record of infertility. Results Of the 308,974 births, 6163 resulted from assisted conception. The unadjusted odds ratio for any birth defect in pregnancies involving assisted conception (513 defects, 8.3%) as compared with pregnancies not involving assisted conception (17,546 defects, 5.8%) was 1.47 (95% confidence interval [CI], 1.33 to 1.62); the multivariate-adjusted odds ratio was 1.28 (95% CI, 1.16 to 1.41). The corresponding odds ratios with in vitro fertilization (IVF) (165 birth defects, 7.2%) were 1.26 (95% CI, 1.07 to 1.48) and 1.07 (95% CI, 0.90 to 1.26), and the odds ratios with intracytoplasmic sperm injection (ICSI) (139 defects, 9.9%) were 1.77 (95% CI, 1.47 to 2.12) and 1.57 (95% CI, 1.30 to 1.90). A history of infertility, either with or without assisted conception, was also significantly associated with birth defects. Conclusions The increased risk of birth defects associated with IVF was no longer significant after adjustment for parental factors. The risk of birth defects associated with ICSI remained increased after multivariate adjustment, although the possibility of residual confounding cannot be excluded. (Funded by the National Health and Medical Research Council and the Australian Research Council.).
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