Children conceived via assisted reproductive technologies (ART) are nowadays a substantial proportion of the population. It is important to follow up these children and evaluate whether they have elevated health risks compared to naturally conceived (NC) children. In recent years there has been a lot of work in this field. This review will summarize what is known about the health of ART-conceived children, encompassing neonatal outcomes, birth defects, growth and gonadal developments, physical health, neurological and neurodevelopmental outcomes, psychosocial developments, risk for cancer, and epigenetic abnormalities. Most of the children conceived after ART are normal. However, there is increasing evidence that ART-conceived children are at higher risk of poor perinatal outcome, birth defects, and epigenetic disorders, and the mechanism(s) leading to these changes have not been elucidated. Continuous follow-up of children after ART is of great importance as they progress through adolescence into adulthood, and new ART techniques are constantly being introduced.
Keywords: Assisted reproductive technologies (ART), Children, Follow-upAssisted reproductive technologies (ART), such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI), are widely used to solve human infertility, and have provided great benefits for millions of couples who have struggled with infertility disorders. Since the first child conceived by IVF was born in 1978, there has been a consistent growth in the use of ART (Nyboe Andersen et al., 2008; de Mouzon et al., 2010; Ferraretti et al., 2012) and more than 4 million babies worldwide have been born via ART. As the offspring of ART have become a substantial proportion of the population, the safety of ART has gained increasing attention.
The many artificial procedures used during ART contribute to the concern that children conceived by ART might be exposed to greater health risks than naturally conceived (NC) children. First, during the ART process, numerous medications are used to induce ovulation, gametes are recruited, embryos are cultured in an in vitro environment and then frozen and thawed, and large doses of progesterone are used to support the luteal phase. All these artificial procedures may harm the gametes and embryos. Furthermore, ICSI, which can fertilize an egg by directly injecting one sperm to the ooplasm, is more invasive than conventional IVF. ICSI also evades natural selection at the oocyte membrane and both genetically and structurally abnormal sperm will be able to fertilize eggs, which may pass abnormal genetic materials to the children. In addition, transferring more than one embryo significantly increases the rate of multiple pregnancies, which is associated with a higher rate of prematurity and low birth weights, carrying high risks of morbidity to the children (Liu and Blair, 2002; Alexander and Salihu, 2005; Fauser et al., 2005). Evidence suggests that even ART singletons are at elevated health risks (Bower and Hansen, 2005; Henningsen et al., 2011; Sazonova et al., 2011), which may due to the poor fertility of the parents.
Worldwide, there are many publications on the topic of ART safety. In this review, we try to summarize the current evidence about whether ART-conceived children are at an increased risk of health problems compared with NC children.
ART-conceived offspring seem to be at a higher risk of lower birth weight, lower gestational age, premature delivery, prenatal mobility, and hospital admission than NC offspring (Schieve et al., 2002; Källén et al., 2005). The main reason for this increased risk is multiple pregnancies, mostly caused by transferring multiple embryos. Following ART, multiple birth rates are between 25% and 50% (Martin et al., 2009; Sunderam et al., 2009; de Mouzon et al., 2010). Single embryo transfer (SET) can significantly decrease the multiple birth rates (Gerris, 2009; Källén B. et al., 2010b), particularly because the blastocyst culture can dramatically increase the likelihood of embryo implantation (Papanikolaou et al., 2008). SET is increasing in popularity in resent years. Compared to conceptions via double embryo transfer (DET), SET can improve neonatal outcome, leading to significantly fewer preterm births and low birth weight infants (Kjellberg et al., 2006).
However, multiple pregnancies are just one factor that is attributed to the poor prenatal outcomes, and thus eliminating multiple births will not completely solve the problem. Many studies found that singletons born after ART are still at a higher risk of lower birth weight, younger gestational age, premature delivery, prenatal mobility, and hospital admission compared with NC singletons (Bower and Hansen, 2005; Henningsen et al., 2011; Sazonova et al., 2011).
Bower and Hansen (2005)’s meta-analysis reviewed all the methodologically sound studies available, examined singletons separately, and found approximately two-fold increases in the risk of perinatal mortality, low birth weight, and preterm birth, an approximate 50% increase in the risk of being small for gestational age, and a 30%–35% increase in birth defects for singletons conceived via ART compared with NC singletons. A recent study with a larger sample by Henningsen et al. (2011), compared the perinatal outcomes of 13 692 pairs (n=27 384 children) of singleton siblings who were conceived via IVF, ICSI, frozen embryo transfer (FET), or spontaneous pregnancy, and found that the mean birth weight was 65 g (95% confidence interval (CI) 41–89), lower in all ART children compared with their NC siblings. In addition, a higher risk of having a low birth weight (LBW; odds ratio (OR) 1.4, 95% CI 1.1–1.7) and a preterm birth (OR 1.3, 95% CI 1.1–1.6) was observed in IVF/ICSI compared with spontaneous conception.
In addition to ART itself, the etiology of infertility or the infertile state of the parents may contribute to the high risk of obstetric outcomes (Romundstad et al., 2008; Hayashi et al., 2012). A population-based cohort study in Norway (Romundstad et al., 2008) assessed the perinatal outcome of 8 229 ART-conceived children compared with 120 092 NC children and found a significantly lower mean birth weight, a shorter duration of gestation, and increased risks of small for gestational age (OR 1.26, 95% CI 1.10–1.44) and perinatal death (OR 1.26, 95% CI 1.10–1.44) in ART-conceived children. However, when the same comparison was performed in sibling-relationship, all the differences disappeared. Recently, a retrospective cohort study in Japan (Hayashi et al., 2012) provided reassuring findings. They compared the perinatal outcomes of singletons who were conceived through ovulation stimulation, intrauterine insemination (IUI), IVF, or through natural conception. Among singleton pregnancies, patients who conceived with ART procedures were at a similarly increased risk for placenta previa, preterm delivery, and low birth weight infant, regardless of the type of ART used.
In addition, Zhang et al. (2010)’s study provided another possibility for why ART children have poorer perinatal outcomes. The ART procedure may affect ART offspring via changing the gene expression in the placenta. Zhang et al. (2010) used microarray analysis to examine the gene expression profiles of the placenta from ART patients and NC control patients. They found that some genes involved in the immune response and cell differentiation regulation were differentially expressed, which may affect fetal development. Unfortunately, their control group comprised fertile couples. Hence, we cannot distinguish whether the effect was come from ART itself or infertility.
Currently, whether ART will affect the perinatal outcome for twins is still controversial. Although several studies found that twins born after ART are at a higher risk of lower birth weight, lower gestational age, premature delivery, prenatal mobility, and hospital admission when compared with NC twins (McDonald et al., 2005; Kanat-Pektas et al., 2008; Hansen et al., 2009), some other studies showed the opposite result (Bower and Hansen, 2005; Boulet et al., 2008). Boulet et al. (2008) compared 1 446 ART twins with 2 729 non-ART twins and found that the risk of premature delivery, low birth weight, and neonatal death was lower in the ART group than in the non-ART group (adjusted OR 0.75, 95% CI 0.58–0.97; 0.75, 0.58–0.95; and 0.55, 0.35–0.88, respectively) among primiparous deliveries, and there were no differences in the risks among multiparous ART and non-ART twin deliveries. These results are similar to our investigation (unpublished). A potential reason for the differences of perinatal outcomes between ART and NC twins is the high rate of dizygotic twins in ART offspring, which results from DET.
In summary, poorer perinatal outcomes are found in ART-conceived children, even for singletons. Infertility is one possible reason, but currently the true mechanism remains unknown. Thus, studies that address these outcomes and whether there is a way to solve it are urgently advocated.
Numerous studies have indicated that children conceived through ART are at a significantly elevated risk of birth defects (Rimm et al., 2004; Bonduelle et al., 2005; Bower and Hansen, 2005; Hansen et al., 2005; Olivennes, 2005; Schieve et al., 2005; Bertelsmann et al., 2008; El-Chaar et al., 2009; Goel et al., 2009; Tararbit et al., 2011; Davies et al., 2012; Mozafari Kermani et al., 2012; Wen et al., 2012). Meta-analyses have shown a 30%–40% increase in the major malformation rates for infants conceived through ART compared with NC children (Rimm et al., 2004; Hansen et al., 2005; Wen et al., 2012). The most recently published meta-analysis by Wen et al. (2012) reviewed 46 studies containing 124 468 IVF/ICSI children and provided a pooled risk estimation of 1.37 (95% CI 1.26–1.48), which is also evident in subgroup analysis (risk ratio (RR) 1.58 for ICSI and 1.30 for IVF; statistical significance was not reached when ICSI was compared with IVF). Furthermore, they assessed the risk for each organ system and found significantly increased risks in each system (RR 2.01 for the nervous system; 1.69 for the genitourinary system; 1.66 for the digestive system; 1.64 for the circulatory system; 1.48 for the musculoskeletal system; and 1.43 for eye, ear, face, and neck). A population-wide cohort study in South Australia (Davies et al., 2012) also found a significantly elevated risk of birth defects in ART (8.3% [513/6 163]) compared with non-ART pregnancies (5.8% [17 546/302 811]) (OR 1.47, 95% CI 1.33–1.62; multivariate-adjusted OR 1.28, 95% CI 1.16–1.41). Only one multi-center large-scale study from China (Yan et al., 2011), encompassing 15 405 ART offspring from seven centers, provides different results. In this study, a total rate of birth defects was 1.23% (189/15 405), which was non-significantly different from that in the general Chinese population (1.35%).
Although the processes of ART are well-studied factors, some investigators believe that the condition of infertility is another important reason for birth defects (Zhu et al., 2006; Rimm et al., 2011). Rimm et al. (2004) published their first meta-analysis on birth defects. In that analysis, they reviewed 19 studies on major malformations in ART-conceived children and found an overall OR of 1.29 (95% CI 1.01–1.67) for ART-conceived children compared with NC controls. However, when taking subfertility into concern, they found an adjusted OR in their second meta-analysis of 1.01 (95% CI 0.82–1.23) (Rimm et al., 2011). They concluded that ART may not increase the risk of birth defects as much as previously reported. Furthermore, the population-wide cohort study of Davies et al. (2012) also found that a history of infertility, either with or without assisted conception, was significantly associated with birth defects. Thus, the infertility situation should be taken into account in future studies.
Intuitively, ICSI is more invasive than IVF and seems fraught with opportunities to damage the embryo, potentially leading to birth defects. Indeed, one multi-center study (Bonduelle et al., 2005), containing 540 ICSI- and 437 IVF-conceived 5-year-old children from five European countries, found that major malformations were more frequently observed in the ICSI group, in particular in ICSI boys, beyond the neonatal period with the majority of these increased defects due to an excess in urogenital malformations. In addition, Davies et al. (2012)’s population-wide cohort study of South Australia found that the OR for birth defects associated with ART, as compared with NC pregnancies, was 1.07 (95% CI 0.90–1.26) for IVF and 1.57 (95% CI 1.30–1.90) for ICSI, after multivariate adjustment; as compared with ICSI, IVF was associated with a reduced risk of birth defect (OR 0.68, 95% CI 0.53–0.87). However, in other recent large studies and meta-analyses, no significant differences were found between ICSI and IVF children (Sutcliffe et al., 2003; Rimm et al., 2004; Lie et al., 2005; Tararbit et al., 2011; Wen et al., 2012).
Whether it is ART procedures or the infertility situation that results in the increased risk of birth defects still remains in debate. Besides long-term follow-up, animal models of ART will be helpful so that the differences of ART population in the causes of infertility as well as in living environments and genetic background could be eliminated.
The growth patterns of ART-conceived children have attracted the attention of many researchers. The vast majority of these studies have not found any differences in the postnatal growth until 12 years old between ART and NC children (Sutcliffe et al., 2003; Bonduelle et al., 2004; 2005; Belva et al., 2007; Knoester et al., 2008; Basatemur et al., 2010; Lee et al., 2010; Woldringh et al., 2011). However, some studies suggest that ART children are taller. Miles et al. (2007) found that IVF/ICSI-conceived children aged 5–6 years were significantly taller than NC controls, following adjustment for age and parental height. In addition, it was observed that IVF children with premature and very low birth weight (
ART have been created to overcome the problem of infertility. Whether the subfertile conditions would affect the offspring is another question. ICSI is used mainly for overcoming male infertility, and the boys who are conceived by ICSI may inherit the impaired testicular function of their father. For these reasons, the gonadal development of ART-conceived offspring has also gained significant attention. Basically, the gonadal development of ART-conceived children is considered to be normal (de Schepper et al., 2009; Belva et al., 2010; 2011; 2012a). A study assessed 8–14-year-old prepubertal and pubertal ICSI-conceived boys and found that the majority had normal testicular and penile size (de Schepper et al., 2009), serum concentrations of anti-Mullerian hormone (AMH) and inhibin B (de Schepper et al., 2009; Belva et al., 2010), and morning salivary testosterone levels (Belva et al., 2011). A study of ICSI-conceived teenagers (Belva et al., 2012a) showed that there were no differences in the menarche, genital development, or pubic hair development, but breast development was less advanced in the females. However, advanced bone age and increased dehydroepiandrosterone (DHEAS) and luteotropic hormone (LH) concentrations in pubertal IVF-conceived girls (Ceelen et al., 2008b), and decreased serum testosterone levels and altered LH to testosterone ratio in ICSI-conceived boys at birth and at three months of age (Mau Kai et al., 2007) were reported.
There are numerous publications about the physical health of ART-conceived children, and the majority of these studies show that ART-conceived children experience similar childhood illnesses (Koivurova et al., 2003; Pinborg et al., 2003; Place and Englert, 2003; Bonduelle et al., 2004; Belva et al., 2007; 2012b; Knoester et al., 2008; Beydoun et al., 2010) and hospital services (Belva et al., 2007; Knoester et al., 2008) compared with NC children. Place et al. (2003) followed 66 ICSI-conceived, 52 IVF-conceived, and 59 NC full-term singletons and prospectively compared the physical health condition of these children, and found no differences among the three groups. Several studies on the physical health of ICSI-conceived children also showed optimistic results (Bonduelle et al., 2004; Belva et al., 2007; 2012b; Knoester et al., 2008). In a recent study by Beydoun et al. (2010), the general health outcomes and the chronic diseases of ART-conceived young adults aged 18–26 years were similar to those of the general population, suggesting that young adults conceived through ART appear to be healthy and well adjusted.
However, some reports have suggested that ART children are more likely to have childhood illnesses (Bonduelle et al., 2005; Källén et al., 2005; Koivurova et al., 2007; Ludwig et al., 2009). A multi-center cohort study (Bonduelle et al., 2005) encompassing 540 ICSI, 437 IVF, and 538 NC children suggested a significantly higher risk of childhood illness, surgery, requiring medical care, and being admitted to hospital in ART-conceived children. Ludwig et al. (2009) found that, although the physical health of ICSI-conceived children was comparable with the health of NC children at age 5.5 years, there was an increase in urogenital surgeries in ICSI-conceived boys because of a significantly increased risk of undescended testicles.
Moreover, healthy children conceived via ART seem to have an elevated risk of suffering from cardiovascular diseases in the future (Ceelen et al., 2008a; Wikstrand et al., 2008; Scott et al., 2010; Scherrer et al., 2012). Ceelen et al. (2008a) found the ART-conceived children 8–18-year-old had higher blood pressure and fasting glucose levels compared with age- and gender-matched controls. Scott et al. (2010) observed altered glucose parameters in young adult mouse offspring conceived by ART. Furthermore, a recent study (Scherrer et al., 2012) of systemic and pulmonary vascular function in 65 healthy ART-conceived children and 57 NC controls highlighted that ART-conceived children were apparently normal but may have had generalized vascular dysfunction. They found that flow-mediated dilation of the brachial artery was 25% smaller ((6.7±1.6)% versus (8.6±1.7)%), carotid-femoral pulse-wave velocity was significantly faster, carotid intima-media thickness was significantly greater, and the systolic pulmonary artery pressure at high altitude (3 450 m) was 30% higher in ART-conceived children than in controls. In addition, Wikstrand et al. (2008) assessed the central retinal vessels of 5-year-old ICSI-conceived children and found abnormal retinal vascularization, especially in ICSI-conceived boys. All these study support that ART-conceived children have a different cardiometabolic condition, and emphasize the importance of long-term follow-up of children conceived through ART.
Neurological sequelae such as cerebral palsy (CP) are more frequently seen in ART-conceived children compared with NC children (Strömberg et al., 2002; Hvidtjørn et al., 2006; 2009; 2010; Klemetti et al., 2006; Romundstad et al., 2008; Källén A.J. et al., 2010; Zhu et al., 2010; Saunders et al., 2011). Although multiple pregnancies and premature delivery after multi-embryo transfer have been attributed as causes (Hvidtjørn et al., 2010; Källén A.J. et al., 2010; Saunders et al., 2011), an increased risk of CP in singletons born after ART has also been reported. A population-based retrospective cohort study (Strömberg et al., 2002) comprising 5 680 IVF children and 11 360 matched controls found that IVF singletons had an increased risk of CP at 2.8 (valued as OR, 95% CI 1.3–5.8). Hvidtjørn et al. (2009) performed a meta-analysis that included nine CP studies of 19 462 ART-conceived children and found that children born after IVF had an increased risk of CP (OR 2.18, 95% CI 1.71–2.77), with a tendency toward an increased risk for CP in IVF singletons compared with non-IVF singletons.
However, the overwhelming majority of the studies on the neurodevelopment of children born at full term after ART consistently show that these children are in a comparable condition to NC children (Källén et al., 2005; Ponjaert-Kristoffersen et al., 2005; Leunens et al., 2006; 2008; Wagenaar et al., 2008; 2009b; Hvidtjørn et al., 2009; Carson et al., 2010; Mains et al., 2010; Tsai et al., 2011). The follow-up studies have all focused on kids and adolescents through 18 years of age because of the short duration of ART’s history. Although the available evidence provides encouraging results, further and long-term follow-up studies are necessary.
Wagenaar et al. (2009a) accessed the behavior and socioemotional functioning of 9–18-year-old (mean age 13.6 years) ART-conceived children through parent and teacher assessments. There were trends towards fewer externalizing behaviors and increasingly withdrawn behaviors or depressive symptoms in the ART-conceived group, as reported by both the parents and teachers. However, no significant differences were found reported by the children themselves (Wagenaar et al., 2011).
Studies on ICSI-conceived children also show reassuring results. Leunens et al. (2006; 2008) followed 8–10-year-old children for cognitive and motor development and found similar results compared with NC children. Using the Infants-Junior Middle School Students’ Social-Life Abilities Scale, the social adjustments of 86 ICSI- and 165 IVF-conceived children of 4–6 years of age were recently compared in China (Xing et al., 2011). No significant differences were found between the ICSI and IVF groups for communication, self-dependence, locomotion, work skills, socialization, or self-management. A publication by Knoester et al. (2007) also showed that child behaviors are comparable after ICSI, IVF, and natural conception. However, the prevalence of autism/autism spectrum disorders (ASDs) seemed higher after ICSI (Knoester et al., 2007).
ASDs are a group of neurobehavioral disorders that are defined by social and communication deficits and repetitive and stereotyped behaviors. Studies about the relationship of ART and ASD have shown inconsistent results (Hvidtjørn et al., 2009), as do the most recent two large investigations. A population-based follow-up study in Denmark (Hvidtjørn et al., 2011) assessed the risk of ASD in ART-conceived children born between January 1995 and December 2003 and found no significant increased risk. Their follow-up time was 4–13 years (median 9 years), 0.68% (225/33 139) of children born after ART and 0.61% (3 394/555 828) of NC children had a diagnosis of ASD. After adjusting for maternal age, educational level, parity, smoking, birth weight, and multiplicity, the adjusted hazard rate ratio (HRR) was 1.13 (95% CI 0.97–1.31). However, another large study from Israel (Zachor and Ben Itzchak, 2011) showed the opposite result. Five hundred and seven children diagnosed with ASD were assessed, and the rate of ART in children with ASD was significantly higher (10.7%) than that in a large Israeli population (3.06%). Based on the inconsistency between the studies available, a well-designed prospective study that assesses the rate of ASD in a large cohort of newborns conceived after ART is very important.
Several studies have revealed the risk of epigenetic disorders in ART-conceived children (Laprise, 2009) and studies have demonstrated the relationship between epigenetic disorders and cancer (Choo, 2011). Whether ART will increase the risk of cancer in the offspring is another current issue. However, due to the rarity of cancer in children, assessing the risk of cancer in ART-conceived children is not easy. Hence, just a handful of studies exist on this topic, and these studies display divergent results.
A Dutch study reported an increased risk of retinoblastoma in children conceived by IVF between 1995 and 2002 (RR 4.9, 95% CI 1.6–11.3) (Moll et al., 2003), but the expanded study between 2002 and 2007 showed no significantly elevated risk (RR 1.29, 95% CI 0.16–4.66) (Marees et al., 2009). In addition, a nation-wide study from France revealed that retinoblastoma is not associated with ART, but is associated with the infertility situation (Foix-L′Hélias et al., 2012). In a case-cohort study by McLaughlin et al. (2006), a 9-fold increase in risk of hepatoblastoma (HB) was observed for those patients with reported or inferred parental infertility treatment. Another case-control study (Puumala et al., 2012a) showed no significant association for any of the measures of parental infertility, or its treatment after adjusting for birth weight and other potential confounders. Recently, a report from nation-wide hospital-based case-control studies in Greece and Sweden has been published. The results suggest that IVF is associated with increased risk of early onset acute lymphoblastic leukemia (ALL) in the offspring. Increased risk of leukemia was observed with 3.8 years earlier in IVF offspring than in the control (OR 2.21, 95% CI 1.27–3.85) (Petridou et al., 2012). Meanwhile, a moderately increased risk of cancer in IVF children (RR 1.42, 95% CI 1.09–1.87) has also been observed by Källén B. et al. (2010a) through a follow-up study of 26 692 children who were born after ART between 1982 and 2005.
In brief, the evidence of cancer risk in children after ART is still very limited. Further studies and long-term follow-up are necessary to determine whether ART had an impact on cancer occurrence.
Epigenetics refers to stably heritable phenotypes “resulting from changes in a chromosome without alterations in the DNA sequence” (Wu and Morris, 2001). Two important regulators of imprinted gene expression are DNA methylation and histone modification. Genomic imprinting is an epigenetic mechanism that regulates DNA methylation, resulting in expression of either the maternal or paternal allele (Koerner and Barlow, 2010). Most imprinted genes are involved in fetal growth and development, while others control behaviors. Imprinting disruption can cause various developmental defects and diseases (Tomizawa and Sasaki, 2012).
Since 2002, several reports have raised concerns that children conceived by ART are at an increased risk of having imprinting disorders, especially some rare and severe imprinting-related diseases, such as Beckwith-Wiedemann syndrome (BWS), Angelman syndrome (AS), and retinoblastoma (Laprise, 2009). There is biological plausibility for such a concern because of the synchrony between ART procedures and crucial imprinting events. Moreover, in animal models, ART affects gene imprinting (Doherty et al., 2000; Khosla et al., 2001; Zaitseva et al., 2007; Li et al., 2011b; Wang N. et al., 2012; Wang L.Y., 2013), particularly for large offspring syndrome (LOF) in sheep and cattle, which is reminiscent of BWS in humans (Young et al., 1998). However, some studies have suggested that the subfertile condition of the parents may also be responsible for imprinting disorders (Horsthemke and Ludwig, 2005; Ludwig et al., 2005). However, other studies show no correlation between ART and genomic imprinting disorders, including BWS and AS (Bowdin et al., 2007), Prader-Willi syndrome (PWS) (Sutcliffe et al., 2006), and retinoblastoma (Lidegaard et al., 2005). The precise risk of imprinting disorders, such as BWS and AS, caused by ART is difficult to estimate because of the rarity of the conditions. Therefore, further and unremitting investigations are needed.
Some epigenetic modifications appear to be dynamic throughout life and could contribute to aging and multifactorial adult-onset diseases (Feinberg, 2007; Petronis, 2010). Thus, ART may result in subtle abnormalities in phenotypically normal children that could present later in life. Katari et al. (2009) evaluated more than 700 genes in cord blood and placental samples and found a modest change in the methylation level of CpG sites from ART-conceived children. Furthermore, a fraction of the differences were associated with altered gene transcription, and several of these genes have been implicated in chronic metabolic disorders, such as obesity and type II diabetes. Gomes et al. (2009) assessed qualitative and quantitative methylation at KvDMR1 using peripheral blood or umbilical cord blood and placentae of 18 children conceived by IVF or ICSI, and found hypomethylation at KvDMR1 in 3 of 18 clinically normal children conceived by ART and a discordant methylation pattern in the 3 corresponding dizygotic twins. Turan et al. (2010) compared two populations of children conceived either in vitro or in vivo, and found aberrant methylation of the differentially methylated region (DMR) of the maternal imprinting control regions (ICR) at the IGF2/H19 locus in samples from in vitro conceptions, although evaluation of the mRNA transcripts did not correlate with these aberrations.
Nevertheless, several recent studies (Tierling et al., 2010; Li et al., 2011a; 2011c; Puumala et al., 2012b; Rancourt et al., 2012) have shown no significant epigenetic differences between ART-conceived and NC offspring. Using bisulfite-based technologies, Tierling et al. (2010) analyzed 10 DMRs of maternal peripheral blood, umbilical cord blood, and amnion/chorion tissue of 185 phenotypically normal children. The results did not reveal any significant differences at nine DMRs among the conception groups in either maternal peripheral blood, umbilical cord blood, or amnion/chorion tissue. In addition, Li et al. (2011a) evaluated 29 pairs of IVF-conceived twins and 30 pairs of NC twins and examined two maternally methylated regions (KvDMR1 and PEG1) and one paternally methylated region (H19/IGF2 DMR). No significant increase in imprint variability at these DMRs was found, except for slightly more variable levels of methylation in IVF cases than in spontaneous cases.
Altogether, ART is likely to cause some epigenetic changes in the offspring, which might be the molecular basis of complex traits and diseases (Gomes et al., 2009). However, it is still unclear whether the small differences observed in several studies represent a real difference between ART-conceived and spontaneously conceived children. Thus, larger studies with long-term follow-up are needed to fully answer these questions.
In conclusion, most children conceived by ART are healthy. The main risks for these children are poorer perinatal outcome, birth defects, and epigenetic disorders. However, whether ART procedures or subfertility itself had led to these changes is still unresolved. Currently, the first IVF-conceived people are now more than 30 years old, and some of them have conceived children. A mouse model study (de Waal et al., 2012) showed that although ART can influence the epigenetic outcome of its offspring, there are no lifelong or transgenerational effects. However, a mouse study may not allow for meaningful conclusions to be drawn in the human case. Thus, the health situation for next generation of ART-conceived children is an important question. In brief, there are still a number of unanswered questions, and further, well-designed studies on the topics described above are urgently needed.
* Project supported by the National Basic Research Program (973) of China (No. 2012CB944901) and the National Natural Science Foundation of China (Nos. 81070532 and 81200475)
Compliance with ethics guidelines: Yue-hong LU, Ning WANG, and Fan JIN declare that they have no conflict of interest.
This article does not contain any studies with human or animal subjects performed by any of the authors.
1. Alexander GR, Salihu HM. Perinatal Outcomes of Singleton and Multiple Births in the United States 1995–1998. In: Blickstein I, Keith LG, editors. Multiple Pregnancy: Epidemiology, Gestation and Perinatal Outcome. UK: Abingdon; 2005. pp. 3–10. [Google Scholar]
2. Basatemur E, Shevlin M, Sutcliffe A. Growth of children conceived by IVF and ICSI up to 12 years of age. Reprod Biomed Online. 2010; 20 (1):144–149. doi: 10.1016/j.rbmo.2009.10.006. [PubMed] [CrossRef] [Google Scholar]
3. Belva F, Henriet S, Liebaers I, van Steirteghem A, Celestin-Westreich S, Bonduelle M. Medical outcome of 8-year-old singleton ICSI children (born ≥32 weeks’ gestation) and a spontaneously conceived comparison group. Hum Reprod. 2007; 22 (2):506–515. doi: 10.1093/humrep/del372. [PubMed] [CrossRef] [Google Scholar]
4. Belva F, Bonduelle M, Painter RC, Schiettecatte J, Devroey P, de Schepper J. Serum inhibin B concentrations in pubertal boys conceived by ICSI: first results. Hum Reprod. 2010; 25 (11):2811–2814. doi: 10.1093/humrep/deq249. [PubMed] [CrossRef] [Google Scholar]
5. Belva F, Bonduelle M, Schiettecatte J, Tournaye H, Painter RC, Devroey P, de Schepper J. Salivary testosterone concentrations in pubertal ICSI boys compared with spontaneously conceived boys. Hum Reprod. 2011; 26 (2):438–441. doi: 10.1093/humrep/deq345. [PubMed] [CrossRef] [Google Scholar]
6. Belva F, Roelants M, Painter R, Bonduelle M, Devroey P, de Schepper J. Pubertal development in ICSI children. Hum Reprod. 2012; 27 (4):1156–1161. doi: 10.1093/humrep/des001. [PubMed] [CrossRef] [Google Scholar]
7. Belva F, Roelants M, de Schepper J, Roseboom TJ, Bonduelle M, Devroey P, Painter RC. Blood pressure in ICSI-conceived adolescents. Hum Reprod. 2012; 27 (10):3100–3108. doi: 10.1093/humrep/des259. [PubMed] [CrossRef] [Google Scholar]
8. Bertelsmann H, de Carvalho Gomes H, Mund M, Bauer S, Matthias K. The risk of malformation following assisted reproduction. Dtsch Arztebl Int. 2008; 105 (1-2):11–17. doi: 10.3238/arztebl.2008.0011. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
9. Beydoun H, Sicignano N, Beydoun M, Matson D, Bocca S, Stadtmauer L, Oehninger S. A cross-sectional evaluation of the first cohort of young adults conceived by in vitro fertilization in the United States. Fertil Steril. 2010; 94 (6):2043–2049. doi: 10.1016/j.fertnstert.2009.12.023. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
10. Bonduelle M, Bergh C, Niklasson A, Palermo GD, Wennerholm UB. Medical follow-up study of 5-year-old ICSI children. Reprod Biomed Online. 2004; 9 (1):91–101. doi: 10.1016/S1472-6483(10)62116-5. [PubMed] [CrossRef] [Google Scholar]
11. Bonduelle M, Wennerholm UB, Loft A, Tarlatzis BC, Peters C, Henriet S, Mau C, Victorin-Cederquist A, van Steirteghem A, Balaska A, et al. A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception. Hum Reprod. 2005; 20 (2):413–419. doi: 10.1093/humrep/deh592. [PubMed] [CrossRef] [Google Scholar]
12. Boulet SL, Schieve LA, Nannini A, Ferre C, Devine O, Cohen B, Zhang Z, Wright V, Macaluso M. Perinatal outcomes of twin births conceived using assisted reproduction technology: a population-based study. Hum Reprod. 2008; 23 (8):1941–1948. doi: 10.1093/humrep/den169. [PubMed] [CrossRef] [Google Scholar]
13. Bowdin S, Allen C, Kirby G, Brueton L, Afnan M, Barratt C, Kirkman-Brown J, Harrison R, Maher E, Reardon W. A survey of assisted reproductive technology births and imprinting disorders. Hum Reprod. 2007; 22 (12):3237–3240. doi: 10.1093/humrep/dem268. [PubMed] [CrossRef] [Google Scholar]
14. Bower C, Hansen M. Assisted reproductive technologies and birth outcomes: overview of recent systematic reviews. Reprod Fertil Dev. 2005; 17 (3):329–333. doi: 10.1071/RD04095. [PubMed] [CrossRef] [Google Scholar]
15. Carson C, Kurinczuk JJ, Sacker A, Kelly Y, Klemetti R, Redshaw M, Quigley MA. Cognitive development following ART: effect of choice of comparison group, confounding and mediating factors. Hum Reprod. 2010; 25 (1):244–252. doi: 10.1093/humrep/dep344. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
16. Ceelen M, van Weissenbruch MM, Vermeiden JP, van Leeuwen FE, Delemarre-van de Waal HA. Cardiometabolic differences in children born after in vitro fertilization: follow-up study. J Clin Endocrinol Metab. 2008; 93 (5):1682–1688. doi: 10.1210/jc.2007-2432. [PubMed] [CrossRef] [Google Scholar]
17. Ceelen M, van Weissenbruch MM, Vermeiden JP, van Leeuwen FE, Delemarre-van de Waal HA. Pubertal development in children and adolescents born after IVF and spontaneous conception. Hum Reprod. 2008; 23 (12):2791–2798. doi: 10.1093/humrep/den309. [PubMed] [CrossRef] [Google Scholar]
18. Ceelen M, van Weissenbruch MM, Prein J, Smit JJ, Vermeiden JP, Spreeuwenberg M, van Leeuwen FE, Delemarre-van de Waal HA. Growth during infancy and early childhood in relation to blood pressure and body fat measures at age 8–18 years of IVF children and spontaneously conceived controls born to subfertile parents. Hum Reprod. 2009; 24 (11):2788–2795. doi: 10.1093/humrep/dep273. [PubMed] [CrossRef] [Google Scholar]
19. Choo KB. Epigenetics in disease and cancer. Malays J Pathol. 2011; 33 (2):61–70. [PubMed] [Google Scholar]
20. Davies MJ, Moore VM, Willson KJ, van Essen P, Priest K, Scott H, Haan EA, Chan A. Reproductive technologies and the risk of birth defects. N Engl J Med. 2012; 366 (19):1803–1813. doi: 10.1056/NEJMoa1008095. [PubMed] [CrossRef] [Google Scholar]
21. de Mouzon J, Goossens V, Bhattacharya S, Castilla JA, Ferraretti AP, Korsak V, Kupka M, Nygren KG, Nyboe Andersen A. Assisted reproductive technology in Europe, 2006: results generated from European registers by ESHRE. Hum Reprod. 2010; 25 (8):1851–1862. doi: 10.1093/humrep/deq124. [PubMed] [CrossRef] [Google Scholar]
22. de Schepper J, Belva F, Schiettecatte J, Anckaert E, Tournaye H, Bonduelle M. Testicular growth and tubular function in prepubertal boys conceived by intracytoplasmic sperm injection. Horm Res. 2009; 71 (6):359–363. doi: 10.1159/000223421. [PubMed] [CrossRef] [Google Scholar]
23. de Waal E, Yamazaki Y, Ingale P, Bartolomei M, Yanagimachi R, McCarrey JR. Primary epimutations introduced during intracytoplasmic sperm injection (ICSI) are corrected by germline-specific epigenetic reprogramming. PNAS. 2012; 109 (11):4163–4168. doi: 10.1073/pnas.1201990109. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
24. Doherty AS, Mann MR, Tremblay KD, Bartolomei MS, Schultz RM. Differential effects of cultureon imprinted H19 expression in the preimplantation mouse embryo. Biol Reprod. 2000; 62 (6):1526–1535. doi: 10.1095/biolreprod62.6.1526. [PubMed] [CrossRef] [Google Scholar]
25. El-Chaar D, Yang Q, Gao J, Bottomley J, Leader A, Wen SW, Walker M. Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertil Steril. 2009; 92 (5):1557–1561. doi: 10.1016/j.fertnstert.2008.08.080. [PubMed] [CrossRef] [Google Scholar]
26. Fauser BC, Devroey P, Macklon NS. Multiple birth resulting from ovarian stimulation for subfertility treatment. Lancet. 2005; 365 (9473):1807–1816. doi: 10.1016/S0140-6736(05)66478-1. [PubMed] [CrossRef] [Google Scholar]
27. Feinberg AP. Phenotypic plasticity and the epigenetics of human disease. Nature. 2007; 447 (7143):433–440. doi: 10.1038/nature05919. [PubMed] [CrossRef] [Google Scholar]
28. Ferraretti AP, Goossens V, de Mouzon J, Bhattacharya S, Castilla JA, Korsak V, Kupka M, Nygren KG, Nyboe Andersen A. Assisted reproductive technology in Europe, 2008: results generated from European registers by ESHRE. Hum Reprod. 2012; 27 (9):2571–2584. doi: 10.1093/humrep/des255. [PubMed] [CrossRef] [Google Scholar]
29. Foix-L′Hélias L, Aerts I, Marchand L, Lumbroso-le Rouic L, Gauthier-Villars M, Labrune P, Bouyer J, Doz F, Kaminski M. Are children born after infertility treatment at increased risk of retinoblastoma? Hum Reprod. 2012; 27 (7):2186–2192. doi: 10.1093/humrep/des149. [PubMed] [CrossRef] [Google Scholar]
30. Gerris J. Single-embryo transfer versus multiple-embryo transfer. Reprod Biomed Online. 2009; 18 (s2):s63–s70. doi: 10.1016/S1472-6483(10)60451-8. [PubMed] [CrossRef] [Google Scholar]
31. Goel A, Sreenivas V, Bhatnagar S, Lodha R, Bhatla N. Risk of birth defects increased in pregnancies conceived by assisted human reproduction. Fertil Steril. 2009; 92 (1):e7. doi: 10.1016/j.fertnstert.2009.02.089. author reply e8. [PubMed] [CrossRef] [Google Scholar]
32. Gomes MV, Huber J, Ferriani RA, Amaral Neto AM, Ramos ES. Abnormal methylation at the KvDMR1 imprinting control region in clinically normal children conceived by assisted reproductive technologies. Mol Hum Reprod. 2009; 15 (8):471–477. doi: 10.1093/molehr/gap038. [PubMed] [CrossRef] [Google Scholar]
33. Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ. Assisted reproductive technologies and the risk of birth defects—a systematic review. Hum Reprod. 2005; 20 (2):328–338. doi: 10.1093/humrep/deh593. [PubMed] [CrossRef] [Google Scholar]
34. Hansen M, Colvin L, Petterson B, Kurinczuk JJ, de Klerk N, Bower C. Twins born following assisted reproductive technology: perinatal outcome and admission to hospital. Hum Reprod. 2009; 24 (9):2321–2331. doi: 10.1093/humrep/dep173. [PubMed] [CrossRef] [Google Scholar]
35. Hayashi M, Nakai A, Satoh S, Matsuda Y. Adverse obstetric and perinatal outcomes of singleton pregnancies may be related to maternal factors associated with infertility rather than the type of assisted reproductive technology procedure used. Fertil Steril. 2012; 98 (4):922–928. doi: 10.1016/j.fertnstert.2012.05.049. [PubMed] [CrossRef] [Google Scholar]
36. Henningsen AK, Pinborg A, Lidegaard Ø, Vestergaard C, Forman JL, Nyboe Andersen A. Perinatal outcome of singleton siblings born after assisted reproductive technology and spontaneous conception: Danish national sibling-cohort study. Fertil Steril. 2011; 95 (3):959–963. doi: 10.1016/j.fertnstert.2010.07.1075. [PubMed] [CrossRef] [Google Scholar]
37. Horsthemke B, Ludwig M. Assisted reproduction: the epigenetic perspective. Hum Reprod Update. 2005; 11 (5):473–482. doi: 10.1093/humupd/dmi022. [PubMed] [CrossRef] [Google Scholar]
38. Hvidtjørn D, Grove J, Schendel DE, Vaeth M, Ernst E, Nielsen LF, Thorsen P. Cerebral palsy among children born after in vitro fertilization: the role of preterm delivery-population-based, cohort study. Pediatrics. 2006; 118 (2):475–482. doi: 10.1542/peds.2005-2585. [PubMed] [CrossRef] [Google Scholar]
39. Hvidtjørn D, Schieve L, Schendel D, Jacobsson B, Svaerke C, Thorsen P. Cerebral palsy, autism spectrum disorders, and developmental delay in children born after assisted conception: a systematic review and meta-analysis. Arch Pediatr Adolesc Med. 2009; 163 (1):72–83. doi: 10.1001/archpediatrics.2008.507. [PubMed] [CrossRef] [Google Scholar]
40. Hvidtjørn D, Grove J, Schendel D, Svaerke C, Schieve LA, Uldall P, Ernst E, Jacobsson B, Thorsen P. Multiplicity and early gestational age contribute to an increased risk of cerebral palsy from assisted conception: a population-based cohort study. Hum Reprod. 2010; 25 (8):2115–2123. doi: 10.1093/humrep/deq070. [PubMed] [CrossRef] [Google Scholar]
41. Hvidtjørn D, Grove J, Schendel D, Schieve LA, Sværke C, Ernst E, Thorsen P. Risk of autism spectrum disorders in children born after assisted conception: a population-based follow-up study. J Epidemiol Community Health. 2011; 65 (6):497–502. doi: 10.1136/jech.2009.093823. [PubMed] [CrossRef] [Google Scholar]
42. Källén AJ, Finnström OO, Lindam AP, Nilsson EM, Nygren KG, Olausson PM. Cerebral palsy in children born after in vitro fertilization. Is the risk decreasing? Eur J Paediatr Neurol. 2010; 14 (6):526–530. doi: 10.1016/j.ejpn.2010.03.007. [PubMed] [CrossRef] [Google Scholar]
43. Källén B, Finnström O, Nygren KG, Olausson PO. In vitro fertilization in Sweden: child morbidity including cancer risk. Fertil Steril. 2005; 84 (3):605–610. doi: 10.1016/j.fertnstert.2005.03.035. [PubMed] [CrossRef] [Google Scholar]
44. Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Olausson PO. Cancer risk in children and young adults conceived by in vitro fertilization. Pediatrics. 2010; 126 (2):270–276. doi: 10.1542/peds.2009-3225. [PubMed] [CrossRef] [Google Scholar]
45. Källén B, Finnström O, Lindam A, Nilsson E, Nygren KG, Olausson PO. Trends in delivery and neonatal outcome after in vitro fertilization in Sweden: data for 25 years. Hum Reprod. 2010; 25 (4):1026–1034. doi: 10.1093/humrep/deq003. [PubMed] [CrossRef] [Google Scholar]
46. Kanat-Pektas M, Kunt C, Gungor T, Mollamahmutoglu L. Perinatal and first year outcomes of spontaneous versus assisted twins: a single center experience. Arch Gynecol Obstet. 2008; 278 (2):143–147. doi: 10.1007/s00404-007-0545-8. [PubMed] [CrossRef] [Google Scholar]
47. Katari S, Turan N, Bibikova M, Erinle O, Chalian R, Foster M, Gaughan JP, Coutifaris C, Sapienza C. DNA methylation and gene expression differences in children conceived in vitro or in vivo. Hum Mol Genet. 2009; 18 (20):3769–3778. doi: 10.1093/hmg/ddp319. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
48. Khosla S, Dean W, Brown D, Reik W, Feil R. Culture of preimplantation mouse embryos affects fetal development and the expression of imprinted gene. Biol Reprod. 2001; 64 (3):918–926. doi: 10.1095/biolreprod64.3.918. [PubMed] [CrossRef] [Google Scholar]
49. Kjellberg AT, Carlsson P, Bergh C. Randomized single versus double embryo transfer: obstetric and paediatric outcome and a cost-effectiveness analysis. Hum Reprod. 2006; 21 (1):210–216. doi: 10.1093/humrep/dei298. [PubMed] [CrossRef] [Google Scholar]
50. Klemetti R, Sevon T, Gissler M, Hemminki E. Health of children born as a result of in vitro fertilization. Pediatrics. 2006; 118 (5):1819–1827. doi: 10.1542/peds.2006-0735. [PubMed] [CrossRef] [Google Scholar]
51. Knoester M, Helmerhorst FM, van der Westerlaken LA, Walther FJ, Veen S Leiden Artificial Reproductive Techniques Follow-up Project (L-art-FUP) Matched follow-up study of 5–8-year-old ICSI singletons: child behaviour, parenting stress and child (health-related) quality of life. Hum Reprod. 2007; 22 (12):3098–3107. doi: 10.1093/humrep/dem261. [PubMed] [CrossRef] [Google Scholar]
52. Knoester M, Helmerhorst FM, Vandenbroucke JP, van der Westerlaken LA, Walther FJ, Veen S. Perinatal outcome, health, growth, and medical care utilization of 5- to 8-year-old intracytoplasmic sperm injection singletons. Fertil Steril. 2008; 89 (5):1133–1146. doi: 10.1016/j.fertnstert.2007.04.049. [PubMed] [CrossRef] [Google Scholar]
53. Koerner MV, Barlow DP. Genomic imprinting—an epigenetic gene-regulatory model. Curr Opin Genet Dev. 2010; 20 (2):164–170. doi: 10.1016/j.gde.2010.01.009. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
54. Koivurova S, Hartikainen AL, Sovio U, Gissler M, Hemminki E, Jarvelin MR. Growth, psychomotor development and morbidity up to 3 years of age in children born after IVF. Hum Reprod. 2003; 18 (11):2328–2336. doi: 10.1093/humrep/deg445. [PubMed] [CrossRef] [Google Scholar]
55. Koivurova S, Hartikainen AL, Gissler M, Hemminki E, Jarvelin MR. Postneonatal hospitalization and health care costs among IVF children: a 7-year follow-up study. Hum Reprod. 2007; 22 (8):2136–2141. doi: 10.1093/humrep/dem150. [PubMed] [CrossRef] [Google Scholar]
56. Laprise SL. Implications of epigenetics and genomic imprinting in assisted reproductive technologies. Mol Reprod Dev. 2009; 76 (11):1006–1018. doi: 10.1002/mrd.21058. [PubMed] [CrossRef] [Google Scholar]
57. Lee SH, Lee MY, Chiang TL, Lee MS, Lee MC. Child growth from birth to 18 months old born after assisted reproductive technology—results of a national birth cohort study. Int J Nurs Stud. 2010; 47 (9):1159–1166. doi: 10.1016/j.ijnurstu.2010.02.006. [PubMed] [CrossRef] [Google Scholar]
58. Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I. Cognitive and motor development of 8-year-old children born after ICSI compared to spontaneously conceived children. Hum Reprod. 2006; 21 (11):2922–2929. doi: 10.1093/humrep/del266. [PubMed] [CrossRef] [Google Scholar]
59. Leunens L, Celestin-Westreich S, Bonduelle M, Liebaers I, Ponjaert-Kristoffersen I. Follow-up of cognitive and motor development of 10-year-old singleton children born after ICSI compared with spontaneously conceived children. Hum Reprod. 2008; 23 (1):105–111. doi: 10.1093/humrep/dem257. [PubMed] [CrossRef] [Google Scholar]
60. Li L, Wang L, Le F, Liu X, Yu P, Sheng J, Huang H, Jin F. Evaluation of DNA methylation status at differentially methylated regions in IVF-conceived newborn twins. Fertil Steril. 2011; 95 (6):1975–1979. doi: 10.1016/j.fertnstert.2011.01.173. [PubMed] [CrossRef] [Google Scholar]
61. Li L, Wang L, Xu X, Lou H, Le F, Li L, Sheng J, Huang H, Jin F. Genome-wide DNA methylation patterns in IVF-conceived mice and their progeny: a putative model for ART-conceived humans. Reprod Toxicol. 2011; 32 (1):98–105. doi: 10.1016/j.reprotox.2011.05.016. [PubMed] [CrossRef] [Google Scholar]
62. Li L, Le F, Wang LY, Xu XR, Lou HY, Zheng YM, Sheng JZ, Huang HF, Jin F. Normal epigenetic inheritance in mice conceived by in vitro fertilization and embryo transfer. J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2011; 12 (10):796–804. doi: 10.1631/jzus.B1000411. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
63. Lidegaard O, Pinborg A, Andersen A. Imprinting diseases and IVF: Danish national IVF cohort study. Hum Reprod. 2005; 20 (4):950–954. doi: 10.1093/humrep/deh714. [PubMed] [CrossRef] [Google Scholar]
64. Lie RT, Lyngstadaas A, Ørstavik KH, Bakketeig LS, Jacobsen G, Tanbo T. Birth defects in children conceived by ICSI compared with children conceived by other IVF-methods: a meta-analysis. Int J Epidemiol. 2005; 34 (3):696–701. doi: 10.1093/ije/dyh363. [PubMed] [CrossRef] [Google Scholar]
65. Liu YC, Blair EM. Predicted birthweight for singletons and twins. Twin Res. 2002; 5 (6):529–537. doi: 10.1375/twin.5.6.529. [PubMed] [CrossRef] [Google Scholar]
66. Ludwig AK, Katalinic A, Thyen U, Sutcliffe AG, Diedrich K, Ludwig M. Physical health at 5.5 years of age of term-born singletons after intracytoplasmic sperm injection: results of a prospective, controlled, single-blinded study. Fertil Steril. 2009; 91 (1):115–124. doi: 10.1016/j.fertnstert.2007.11.037. [PubMed] [CrossRef] [Google Scholar]
67. Ludwig M, Katalinic A, Gro S, Sutcliffe A, Varon R, Horsthemke B. Increased prevalence of imprinting defects in patients with Angelman syndrome born to subfertile couples. J Med Genet. 2005; 42 (4):289–291. doi: 10.1136/jmg.2004.026930. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
68. Mains L, Zimmerman M, Blaine J, Stegmann B, Sparks A, Ansley T, van Voorhis B. Achievement test performance in children conceived by IVF. Hum Reprod. 2010; 25 (10):2605–2611. doi: 10.1093/humrep/deq218. [PubMed] [CrossRef] [Google Scholar]
69. Makhoul IR, Tamir A, Bader D, Rotschild A, Weintraub Z, Yurman S, Reich D, Bental Y, Jammalieh J, Smolkin T, et al. In vitro fertilisation and use of ovulation enhancers may both influence childhood height in very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2009; 94 (5):F355–F359. doi: 10.1136/adc.2008.144402. [PubMed] [CrossRef] [Google Scholar]
70. Marees T, Dommering CJ, Imhof SM, Kors WA, Ringens PJ, van Leeuwen FE, Moll AC. Incidence of retinoblastoma in Dutch children conceived by IVF: an expanded study. Hum Reprod. 2009; 24 (12):3220–3224. doi: 10.1093/humrep/dep335. [PubMed] [CrossRef] [Google Scholar]
71. Martin J, Hamilton B, Sutton P, Ventura S, Menacker F, Kirmeyer S, Mathews T. Births: final data for 2006. Natl Vital Stat Rep. 2009; 57 (7):1–104. [PubMed] [Google Scholar]
72. Mau Kai C, Main KM, Nyboe Andersen A, Loft A, Skakkebaek NE, Juul A. Reduced serum testosterone levels in infant boys conceived by intracytoplasmic sperm injection. J Clin Endocrinol Metab. 2007; 92 (7):2598–2603. doi: 10.1210/jc.2007-0095. [PubMed] [CrossRef] [Google Scholar]
73. McDonald S, Murphy K, Beyene J, Ohlsson A. Perinatal outcomes of in vitro fertilization twins: a systematic review and meta-analyses. Am J Obstet Gynecol. 2005; 193 (1):141–152. doi: 10.1016/j.ajog.2004.11.064. [PubMed] [CrossRef] [Google Scholar]
74. McLaughlin CC, Baptiste MS, Schymura MJ, Nasca PC, Zdeb MS. Maternal and infant birth characteristics and hepatoblastoma. Am J Epidemiol. 2006; 163 (9):818–828. doi: 10.1093/aje/kwj104. [PubMed] [CrossRef] [Google Scholar]
75. Miles HL, Hofman PL, Peek J, Harris M, Wilson D, Robinson EM, Gluckman PD, Cutfield WS. In vitro fertilization improves childhood growth and metabolism. J Clin Endocrinol Metab. 2007; 92 (9):3441–3445. doi: 10.1210/jc.2006-2465. [PubMed] [CrossRef] [Google Scholar]
76. Moll AC, Imhof SM, Cruysberg JR, Schouten-van Meeteren AY, Boers M, van Leeuwen FE. Incidence of retinoblastoma in children born after in-vitro fertilisation. Lancet. 2003; 361 (9354):309–310. doi: 10.1016/S0140-6736(03)12332-X. [PubMed] [CrossRef] [Google Scholar]
77. Mozafari Kermani R, Nedaeifard L, Nateghi MR, Shahzadeh Fazeli A, Ahmadi E, Osia MA, Jafarzadehpour E, Nouri S. Congenital anomalies in infants conceived by assisted reproductive techniques. Arch Iran Med. 2012; 15 (4):228–231. [PubMed] [Google Scholar]
78. Nyboe Andersen N, Goossens V, Ferraretti AP, Bhattacharya S, Felberbaum R, de Mouzon J, Nygren KG. Assisted reproductive technology in Europe, 2004: results generated from European registers by ESHRE. Hum Reprod. 2008; 23 (4):756–771. doi: 10.1093/humrep/den014. [PubMed] [CrossRef] [Google Scholar]
79. Olivennes F. Do children born after assisted reproductive technology have a higher incidence of birth defects? Fertil Steril. 2005; 84 (5):1325–1326. doi: 10.1016/j.fertnstert.2005.05.044. discussion 1327. [PubMed] [CrossRef] [Google Scholar]
80. Papanikolaou EG, Kolibianakis EM, Tournaye H, Venetis CA, Fatemi H, Tarlatzis B, Devroey P. Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in IVF. A systematic review and meta-analysis. Hum Reprod. 2008; 23 (1):91–99. doi: 10.1093/humrep/dem339. [PubMed] [CrossRef] [Google Scholar]
81. Petridou ET, Sergentanis TN, Panagopoulou P, Moschovi M, Polychronopoulou S, Baka M, Pourtsidis A, Athanassiadou F, Kalmanti M, Sidi V, et al. In vitro fertilization and risk of childhood leukemia in Greece and Sweden. Pediatr Blood Cancer. 2012; 58 (6):930–936. doi: 10.1002/pbc.23194. [PubMed] [CrossRef] [Google Scholar]
82. Petronis A. Epigenetics as a unifying principle in the aetiology of complex traits and diseases. Nature. 2010; 465 (7299):721–727. doi: 10.1038/nature09230. [PubMed] [CrossRef] [Google Scholar]
83. Pinborg A, Loft A, Schmidt L, Nyboe Andersen A. Morbidity in a Danish National cohort of 472 IVF/ICSI twins, 1132 non-IVF/ICSI twins and 634 IVF/ICSI singletons: health-related and social implications for the children and their families. Hum Reprod. 2003; 18 (6):1234–1243. doi: 10.1093/humrep/deg257. [PubMed] [CrossRef] [Google Scholar]
84. Place I, Englert Y. A prospective longitudinal study of the physical, psychomotor, and intellectual development of singleton children up to 5 years who were conceived by intracytoplasmic sperm injection compared with children conceived spontaneously and by in vitro fertilization. Fertil Steril. 2003; 80 (6):1388–1397. doi: 10.1016/j.fertnstert.2003.06.004. [PubMed] [CrossRef] [Google Scholar]
85. Ponjaert-Kristoffersen I, Bonduelle M, Barnes J, Nekkebroeck J, Loft A, Wennerholm UB, Tarlatzis BC, Peters C, Hagberg BS, Berner A, et al. International collaborative study of intracytoplasmic sperm injection-conceived, in vitro fertilization-conceived, and naturally conceived 5-year-old child outcomes: cognitive and motor assessments. Pediatrics. 2005; 115 (3):e283–e289. doi: 10.1542/peds.2004-1445. [PubMed] [CrossRef] [Google Scholar]
86. Puumala SE, Ross JA, Feusner JH, Tomlinson GE, Malogolowkin MH, Krailo MD, Spector LG. Parental infertility, infertility treatment and hepatoblastoma: a report from the Children’s Oncology Group. Hum Reprod. 2012; 27 (6):1649–1656. doi: 10.1093/humrep/des109. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
87. Puumala SE, Nelson HH, Ross JA, Nguyen RH, Damario MA, Spector LG. Similar DNA methylation levels in specific imprinting control regions in children conceived with and without assisted reproductive technology: a cross-sectional study. BMC Pediatr. 2012; 12 (1):33. doi: 10.1186/1471-2431-12-33. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
88. Rancourt RC, Harris HR, Michels KB. Methylation levels at imprinting control regions are not altered with ovulation induction or in vitro fertilization in a birth cohort. Hum Reprod. 2012; 27 (7):2208–2216. doi: 10.1093/humrep/des151. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
89. Rimm AA, Katayama AC, Diaz M, Katayama KP. A meta-analysis of controlled studies comparing major malformation rates in IVF and ICSI infants with naturally conceived children. J Assist Reprod Genet. 2004; 21 (12):437–443. doi: 10.1007/s10815-004-8760-8. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
90. Rimm AA, Katayama AC, Katayama KP. A meta-analysis of the impact of IVF and ICSI on major malformations after adjusting for the effect of subfertility. J Assist Reprod Genet. 2011; 28 (8):699–705. doi: 10.1007/s10815-011-9583-z. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
91. Romundstad LB, Romundstad PR, Sunde A, von Düring V, Skjaerven R, Gunnell D, Vatten LJ. Effects of technology or maternal factors on perinatal outcome after assisted fertilisation: a population-based cohort study. Lancet. 2008; 372 (9640):737–743. doi: 10.1016/S0140-6736(08)61041-7. [PubMed] [CrossRef] [Google Scholar]
92. Saunders NR, Hellmann J, Farine D. Cerebral palsy and assisted conception. J Obstet Gynaecol Can. 2011; 33 (10):1038–1043. [PubMed] [Google Scholar]
93. Sazonova A, Källen K, Thurin-Kjellberg A, Wennerholm UB, Bergh C. Obstetric outcome after in vitro fertilization with single or double embryo transfer. Hum Reprod. 2011; 26 (2):442–450. doi: 10.1093/humrep/deq325. [PubMed] [CrossRef] [Google Scholar]
94. Scherrer U, Rimoldi SF, Rexhaj E, Stuber T, Duplain H, Garcin S, de Marchi SF, Nicod P, Germond M, Allemann Y, et al. Systemic and pulmonary vascular dysfunction in children conceived by assisted reproductive technologies. Circulation. 2012; 125 (15):1890–1896. doi: 10.1161/CIRCULATIONAHA.111.071183. [PubMed] [CrossRef] [Google Scholar]
95. Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G, Wilcox LS. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med. 2002; 346 (10):731–737. doi: 10.1056/NEJMoa010806. [PubMed] [CrossRef] [Google Scholar]
96. Schieve LA, Rasmussen SA, Reefhuis J. Risk of birth defects among children conceived with assisted reproductive technology: providing an epidemiologic context to the data. Fertil Steril. 2005; 84 (5):1320–1324. doi: 10.1016/j.fertnstert.2005.04.066. discussion 1327. [PubMed] [CrossRef] [Google Scholar]
97. Scott KA, Yamazaki Y, Yamamoto M, Lin Y, Melhorn SJ, Krause EG, Woods SC, Yanagimachi R, Sakai RR, Tamashiro KL. Glucose parameters are altered in mouse offspring produced by assisted reproductive technologies and somatic cell nuclear transfer. Biol Reprod. 2010; 83 (2):220–227. doi: 10.1095/biolreprod.109.082826. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
98. Strömberg B, Dahlquist G, Ericson A, Finnström O, Köster M, Stjernqvist K. Neurological sequelae in children born after in-vitro fertilisation: a population based study. Lancet. 2002; 359 (9305):461–465. doi: 10.1016/S0140-6736(02)07674-2. [PubMed] [CrossRef] [Google Scholar]
99. Sunderam S, Chang J, Flowers L, Kulkarni A, Sentelle G, Jeng G, Macaluso M. Assisted reproductive technology surveillance—United States, 2006. Morb Mortal Wkly Rep. 2009; 58 :1–25. [PubMed] [Google Scholar]
100. Sutcliffe AG, Saunders K, McLachlan R, Taylor B, Edwards P, Grudzinskas G, Leiberman B, Thornton S. A retrospective case-control study of developmental and other outcomes in a cohort of Australian children conceived by intracytoplasmic sperm injection compared with a similar group in the United Kingdom. Fertil Steril. 2003; 79 (3):512–516. doi: 10.1016/S0015-0282(02)04701-5. [PubMed] [CrossRef] [Google Scholar]
101. Sutcliffe AG, Peters CJ, Bowdin S, Temple K, Reardon W, Wilson L, Clayton-Smith J, Brueton LA, Bannister W, Maher ER. Assisted reproductive therapies and imprinting disorders—a preliminary British survey. Hum Reprod. 2006; 21 (4):1009–1011. doi: 10.1093/humrep/dei405. [PubMed] [CrossRef] [Google Scholar]
102. Tararbit K, Houyel L, Bonnet D, de Vigan C, Lelong N, Goffinet F, Khoshnood B. Risk of congenital heart defects associated with assisted reproductive technologies: a population-based evaluation. Eur Heart J. 2011; 32 (4):500–508. doi: 10.1093/eurheartj/ehq440. [PubMed] [CrossRef] [Google Scholar]
103. Tierling S, Souren NY, Gries J, Loporto C, Groth M, Lutsik P, Neitzel H, Utz-Billing I, Gillessen-Kaesbach G, Kentenich H, et al. Assisted reproductive technologies do not enhance the variability of DNA methylation imprints in human. J Med Genet. 2010; 47 (6):371–376. doi: 10.1136/jmg.2009.073189. [PubMed] [CrossRef] [Google Scholar]
104. Tomizawa S, Sasaki H. Genomic imprinting and its relevance to congenital disease, infertility, molar pregnancy and induced pluripotent stem cell. J Hum Genet. 2012; 57 (2):84–91. doi: 10.1038/jhg.2011.151. [PubMed] [CrossRef] [Google Scholar]
105. Tsai CC, Huang FJ, Wang LJ, Lin YJ, Kung FT, Hsieh CH, Lan KC. Clinical outcomes and development of children born after intracytoplasmic sperm injection (ICSI) using extracted testicular sperm or ejaculated extreme severe oligo-astheno-teratozoospermia sperm: a comparative study. Fertil Steril. 2011; 96 (3):567–571. doi: 10.1016/j.fertnstert.2011.06.080. [PubMed] [CrossRef] [Google Scholar]
106. Turan N, Katari S, Gerson LF, Chalian R, Foster MW, Gaughan JP, Coutifaris C, Sapienza C. Inter- and intra-individual variation in allele-specific DNA methylation and gene expression in children conceived using assisted reproductive technology. PLoS Genet. 2010; 6 (7):e1001033. doi: 10.1371/journal.pgen.1001033. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
107. Wagenaar K, Ceelen M, van Weissenbruch M, Knol DL, Delemarre-van de Waal H, Huisman J. School functioning in 8 to 18-year-old children born after in vitro fertilization. Eur J Pediatr. 2008; 167 (11):1289–1295. doi: 10.1007/s00431-008-0677-2. [PubMed] [CrossRef] [Google Scholar]
108. Wagenaar K, van Weissenbruch MM, Knol DL, Cohen-Kettenis PT, Delemarre-van de Waal HA, Huisman J. Behavior and socioemotional functioning in 9—18-year-old children born after in vitro fertilization. Fertil Steril. 2009; 92 (6):1907–1914. doi: 10.1016/j.fertnstert.2008.09.026. [PubMed] [CrossRef] [Google Scholar]
109. Wagenaar K, van Weissenbruch M, Knol DL. Information processing, attention and visual-motor function of adolescents born after in vitro fertilization compared with spontaneous conception. Hum Reprod. 2009; 24 (4):913–921. doi: 10.1093/humrep/den455. [PubMed] [CrossRef] [Google Scholar]
110. Wagenaar K, van Weissenbruch MM, van Leeuwen FE, Cohen-Kettenis PT, Delemarre-van de Waal HA, Schats R, Huisman J. Self-reported behavioral and socioemotional functioning of 11- to 18-year-old adolescents conceived by in vitro fertilization. Fertil Steril. 2011; 95 (2):611–616. doi: 10.1016/j.fertnstert.2010.04.076. [PubMed] [CrossRef] [Google Scholar]
111. Wang LY, Wang N, Le F, Li L, Li LJ, Liu XZ, Zheng YM, Lou HY, Xu XR, Zhu XM, et al. Persistence and intergenerational transmission of differentially expressed genes in the testes of intracytoplasmic sperm injection conceived mice. J Zhejiang Univ-Sci B (Biomed & Biotechnol) 2013; 14 (5):372–381. doi: 10.1631/jzus.B1200321. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
112. Wang N, Le F, Liu X, Zhan Q, Wang L, Sheng J, Huang H, Jin F. Altered expressions and DNA methylation of imprinted genes in chromosome 7 in brain of mouse offspring conceived from in vitro maturation. Reprod Toxicol. 2012; 34 (3):420–428. doi: 10.1016/j.reprotox.2012.04.012. [PubMed] [CrossRef] [Google Scholar]
113. Wen J, Jiang J, Ding C, Dai J, Liu Y, Xia Y, Liu J, Hu Z. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis. Fertil Steril. 2012; 97 (6):1331–1337. doi: 10.1016/j.fertnstert.2012.02.053. [PubMed] [CrossRef] [Google Scholar]
114. Wikstrand MH, Niklasson A, Strömland K, Hellström A. Abnormal vessel morphology in boys born after intracytoplasmic sperm injection. Acta Paediatr. 2008; 97 (11):1512–1517. doi: 10.1111/j.1651-2227.2008.00959.x. [PubMed] [CrossRef] [Google Scholar]
115. Woldringh GH, Hendriks JC, van Klingeren J, van Buuren S, Kollée LA, Zielhuis GA, Kremer JA. Weight of in vitro fertilization and intracytoplasmic sperm injection singletons in early childhood. Fertil Steril. 2011; 95 (8):2775–2777. doi: 10.1016/j.fertnstert.2010.12.037. [PubMed] [CrossRef] [Google Scholar]
116. Wu C, Morris JR. Genes, genetics, and epigenetics: a correspondence. Science. 2001; 293 (5532):1103–1105. doi: 10.1126/science.293.5532.1103. [PubMed] [CrossRef] [Google Scholar]
117. Xing LF, Qu F, Qian YL, Zhang FH, Zhu YM, Xu XF. The social adaptation of children born after ICSI compared with IVF-conceived children: a study from China. J Obstet Gynaecol. 2011; 31 (8):751–753. doi: 10.3109/01443615.2011.606937. [PubMed] [CrossRef] [Google Scholar]
118. Yan J, Huang G, Sun Y, Zhao X, Chen S, Zou S, Hao C, Quan S, Chen ZJ. Birth defects after assisted reproductive technologies in China: analysis of 15405 offspring in seven centers (2004 to 2008) Fertil Steril. 2011; 95 (1):458–460. doi: 10.1016/j.fertnstert.2010.08.024. [PubMed] [CrossRef] [Google Scholar]
119. Young LE, Sinclair KD, Wilmut I. Large offspring syndrome in cattle and sheep. Rev Reprod. 1998; 3 (3):155–163. doi: 10.1530/ror.0.0030155. [PubMed] [CrossRef] [Google Scholar]
120. Zachor DA, Ben Itzchak E. Assisted reproductive technology and risk for autism spectrum disorder. Res Dev Disabil. 2011; 32 (6):2950–2956. doi: 10.1016/j.ridd.2011.05.007. [PubMed] [CrossRef] [Google Scholar]
121. Zaitseva I, Zaitsev S, Alenina N, Bader M, Krivokharchenko A. Dynamics of DNA-demethylationin early mouse and rat embryos developed in vivo and in vitro. Mol Reprod Dev. 2007; 74 (10):1255–1261. doi: 10.1002/mrd.20704. [PubMed] [CrossRef] [Google Scholar]
122. Zhang Y, Cui Y, Zhou Z, Sha J, Li Y, Liu J. Altered global gene expressions of human placentae subjected to assisted reproductive technology treatments. Placenta. 2010; 31 (4):251–258. doi: 10.1016/j.placenta.2010.01.005. [PubMed] [CrossRef] [Google Scholar]
123. Zhu JL, Basso O, Obel C, Bille C, Olsen J. Infertility, infertility treatment, and congenital malformations: Danish national birth cohort. BMJ. 2006; 333 (7570):679. doi: 10.1136/bmj.38919.495718.AE. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
124. Zhu JL, Hvidtjørn D, Basso O, Obel C, Thorsen P, Uldall P, Olsen J. Parental infertility and cerebral palsy in children. Hum Reprod. 2010; 25 (12):3142–3145. doi: 10.1093/humrep/deq206. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
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