Fertility Treatment and Risk of Childhood Mental Disorders
Fertility Treatment and Risk of Childhood Mental Disorders
Objective. To assess the mental health of children born after fertility treatment by comparing their risk of mental disorders with that of spontaneously conceived children.
Design. Prospective register based cohort study.
Setting. Nationwide register based information from Danish National Health Registers cross linked by a unique personal identification number assigned to all citizens in Denmark.
Participants. All children born in Denmark in 1995-2003 with follow-up in 2012 when the children were aged 8-17; 33,139 children were conceived after fertility treatment and 555,828 children were born after spontaneous conception.
Main Outcome Measures. Absolute risks and hazard ratios for overall and specific mental disorders estimated with adjustment for potential confounding variables. Estimated association between the risk of mental disorders and subtypes of procedures, hormone treatments, gamete types, and cause of infertility.
Results. The risk of mental disorders in children born after in vitro fertilisation or intracytoplasmic sperm injection was low, and was no higher than in spontaneously conceived children, except for a borderline significant increased risk of tic disorders (hazard ratio 1.40, 95% confidence interval 1.01 to 1.95; absolute risk 0.3%). In contrast, children born after ovulation induction with or without insemination had low but significantly increased risks of any mental disorder (1.20, 1.11 to 1.31; absolute risk 4.1%), autism spectrum disorders (1.20, 1.05 to 1.37; 1.5%), hyperkinetic disorders (1.23, 1.08 to 1.40; 1.7%), conduct, emotional, or social disorder (1.21, 1.02 to 1.45; 0.8%), and tic disorders (1.51, 1.16 to 1.96; 0.4%). There was no risk systematically related to any specific type of hormone drug treatment.
Conclusions. There was a small increase in the incidence of mental disorders in children born after ovulation induction/intrauterine insemination. Children born after in vitro fertilisation/intracytoplasmic sperm injection were found to have overall risk comparable with children conceived spontaneously.
Assisted reproduction techniques, induced ovulation, and intrauterine insemination are now widely used in the treatment of infertility, and in some countries children conceived after any medical assistance constitute up to 9% of newborns. While over five million children have been born after assisted reproduction, concerns are still being raised about potential adverse effects related to these procedures.
Results from long term follow-up are sparse and inconsistent. Associations with behavioural or socioemotional development, cognitive development, psychomotor development, or risk of mental disorders such as attention-deficit/hyperactivity disorder (ADHD) have been observed in some but not all studies. Furthermore, few studies have included children born after induced ovulation.
We conducted a cohort study to investigate whether children conceived after fertility treatments have a higher, comparable, or lower risk of mental disorders in childhood or adolescence compared with children born after spontaneous conception. The study was based on a long term national register based follow-up in a large unselected cohort of children born after fertility treatments and aimed to overcome some limitations of previous studies regarding study size, follow-up time, and risk of bias.
Abstract and Introduction
Abstract
Objective. To assess the mental health of children born after fertility treatment by comparing their risk of mental disorders with that of spontaneously conceived children.
Design. Prospective register based cohort study.
Setting. Nationwide register based information from Danish National Health Registers cross linked by a unique personal identification number assigned to all citizens in Denmark.
Participants. All children born in Denmark in 1995-2003 with follow-up in 2012 when the children were aged 8-17; 33,139 children were conceived after fertility treatment and 555,828 children were born after spontaneous conception.
Main Outcome Measures. Absolute risks and hazard ratios for overall and specific mental disorders estimated with adjustment for potential confounding variables. Estimated association between the risk of mental disorders and subtypes of procedures, hormone treatments, gamete types, and cause of infertility.
Results. The risk of mental disorders in children born after in vitro fertilisation or intracytoplasmic sperm injection was low, and was no higher than in spontaneously conceived children, except for a borderline significant increased risk of tic disorders (hazard ratio 1.40, 95% confidence interval 1.01 to 1.95; absolute risk 0.3%). In contrast, children born after ovulation induction with or without insemination had low but significantly increased risks of any mental disorder (1.20, 1.11 to 1.31; absolute risk 4.1%), autism spectrum disorders (1.20, 1.05 to 1.37; 1.5%), hyperkinetic disorders (1.23, 1.08 to 1.40; 1.7%), conduct, emotional, or social disorder (1.21, 1.02 to 1.45; 0.8%), and tic disorders (1.51, 1.16 to 1.96; 0.4%). There was no risk systematically related to any specific type of hormone drug treatment.
Conclusions. There was a small increase in the incidence of mental disorders in children born after ovulation induction/intrauterine insemination. Children born after in vitro fertilisation/intracytoplasmic sperm injection were found to have overall risk comparable with children conceived spontaneously.
Introduction
Assisted reproduction techniques, induced ovulation, and intrauterine insemination are now widely used in the treatment of infertility, and in some countries children conceived after any medical assistance constitute up to 9% of newborns. While over five million children have been born after assisted reproduction, concerns are still being raised about potential adverse effects related to these procedures.
Results from long term follow-up are sparse and inconsistent. Associations with behavioural or socioemotional development, cognitive development, psychomotor development, or risk of mental disorders such as attention-deficit/hyperactivity disorder (ADHD) have been observed in some but not all studies. Furthermore, few studies have included children born after induced ovulation.
We conducted a cohort study to investigate whether children conceived after fertility treatments have a higher, comparable, or lower risk of mental disorders in childhood or adolescence compared with children born after spontaneous conception. The study was based on a long term national register based follow-up in a large unselected cohort of children born after fertility treatments and aimed to overcome some limitations of previous studies regarding study size, follow-up time, and risk of bias.
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