Is Assisted Reproduction Too Risky for Kids?

The bioethics of in vitro fertilization and birth defects

Children conceived by means of some assisted reproductive technologies (ART) run a higher risk of being born with birth defects than do children conceived spontaneously, according to a new study in the journal Fertility and Sterility.

This has provoked some handwringing by University of Pennsylvania bioethicist Arthur Caplan, who observes that the study “showed large increase in the risk of having a child with a birth defect. The risk was 37 percent higher than that seen in children made the old fashioned way. That is a huge number.” Caplan adds, “The large risk factor now on the table needs to be a key part of how everyone thinks about making babies in medical settings.”

The researchers looked at the rate of birth defects reported in 46 studies of children born using regular in vitro fertilization (IVF) producing embryos by exposing eggs in a lab dish to sperm and then transferring them to a womb and intracytoplasmic sperm injection (ICSI) in which a single sperm is injected directly into an egg. The studies encompassed the births of just under 125,000 children worldwide. The researchers also wanted to see if there was any difference in the birth defect rates between regular IVF and ICSI. They did not find much difference in the rate of birth defects between the two assisted reproductive techniques.

Prior studies have also found an increase in birth defects among children born by means of assisted reproduction. So what is the magnitude of the risks? I am a bit puzzled about the way that Caplan characterized the results of the new study. What the researchers actually report is an increase in the relative risk of IVF and ICSI birth defects compared to the risk of birth defects among children born through what the fertility gurus label “spontaneous” conception. In the United States the rate of birth defects among children born by spontaneous means is about 3 out of 100. What does a 37 percent increase in birth defects among IVF babies represent? Basically, it means that the researchers found that 4 out of 100 IVF babies are born with birth defects. That is not nothing, but it sure does sound less scary than a 37 percent increase.

How to account for this reported increase in birth defects associated with assisted reproduction? The researchers note that the defects could be due to the underlying infertility of couples seeking treatment. For example, one study found that children born to subfertile couples (often defined as those who took longer than one year to conceive) have a higher rate of birth defects. It is also possible that the laboratory handling of eggs and sperm and embryos somehow damages them and thus increases the risk of birth defects. However, one study that looked at a group of IVF kids with birth defects could not find evidence that the IVF lab procedures were the cause. And it may be that closer scrutiny of children born by means of ART results in a higher reported rate of birth defects, thus misleadingly boosting the apparent relative risk.

Based on this study, Caplan asserts, “We need to be sure that long-term monitoring of children born by means of infertility treatment is routine and that more research is done into the causes of health problems for kids who cannot make choices about facing risk.” First, as far as I can tell most studies that have monitored IVF kids are reassuring. For example, a 2010 follow up study of IVF kids up to grade 12 reported, “IVF children scored higher on standardized tests than their matched peers, suggesting that IVF does not have a negative effect on cognitive development.” An earlier study had suggested that children conceived using IVF were taller than spontaneously conceived children. However, a subsequent study found no such difference.

Look, if these data stand up, then of course people who are considering using IVF should be told about the increased risks to their potential children. But how likely is it that parents would decide not to risk having a kid because there is a 3 percent chance they would suffer from a significant birth defect? That’s the normal risk that any parent and any would-be kid face now. So raise the chance to 4 percent. How many people would change their minds about having a kid because of that increased risk? I suspect not too many.

Consequently, I am not quite sure what to make of Caplan’s ominous assertion that seems to suggest that the risks faced by kids born via assisted reproduction are somehow more ethically significant than the risks faced by children born by conventional means. Nobody gets to choose who their parents are or what their characteristics will be before birth. ART and spontaneously conceived kids stand in the exactly the same ethical relation to their parents with regard to the risks of being born.

Ronald Bailey is Reason's science correspondent. His book Liberation Biology: The Scientific and Moral Case for the Biotech Revolution is now available from Prometheus Books

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  • ||

    How does that image not have alt-text? I am quite disappointed.

  • R||

    It does on the link to this story in the Hit and Run section. It's just not very good.

  • Old Mexican||

    In the United States the rate of birth defects among children born by spontaneous means is about 3 out of 100. What does a 37 percent increase in birth defects among IVF babies represent? Basically, it means that the researchers found that 4 out of 100 IVF babies are born with birth defects. That is not nothing, but it sure does sound less scary than a 37 percent increase.


    There are lies, damned lies and then there are statistics.

    Caplan adds, "The large risk factor now on the table needs to be a key part of how everyone thinks about making babies in medical settings."


    Translation: I have no idea what Risk Analysis is all about!

  • Paul.||

    Caplan adds, "The large risk factor now on the table needs to be a key part of how everyone thinks about making babies in medical settings.

    I haven't read the article yet, but I'm guessing someone somewhere is demanding that there be some regulatory oversight (some sort of Czar will be appointed, undoubtedly a medical 'ethicist' will be in charge) for the "fertility industry".

    Because reproductive choice is only about abortion on demand. Women making other choices about their reproduction? Mmm... not so much.

  • Pip||

    Right you are.

  • Paul.||

    "We need to be sure that long-term monitoring of children born by means of infertility treatment is routine and that more research is done into the causes of health problems for kids who cannot make choices about facing risk."

    Hmmm. Hmmmmmm. Hmmmmmmmmmm.

    I'm thinking about another group which justifies its meddling into peoples choices based on the premise that "the children have no choice in the matter".

    Once again, another 'bioethicist' opens his mouth and I immediately feel uneasy about what he's asserting.

  • Almanian's Evil Twin||

    You know who else meddled with people's choices...

  • johnl||

    Who would have thought that parents with fertility problems, when they are able to produce live children at all, end up with slightly more birth defects? Sound the alarm!

  • johnl||

    If you don't want to risk having to use IVF then *hurry up*. http://en.wikipedia.org/wiki/F....._fertility

  • DrC||

    My Wife is preggers with our first IVF love child. She has poly cystic ovarian syndrome. Doubt some chromosomal abnormality. But the process seems to not insure survival of the fittest. I'll take 4% risk. We have been trying for almost 3 years and finally are pregnant. The infertility industry is driven mostly by private paying or very good insurance. I suspect the government wants to get its filthy hands on this industry. next they will come up with some other junk science regarding other profitable private pay health care industries such as lasik.

  • johnl||

    Good luck!

  • LarryA||

    I hope you do as well as we did: two healthy bouncing grandkids that are going to drive our daughter just as crazy as she did us.

  • Almanian's Evil Twin||

    Good luck to you! We had three kids with no "help"....and each was a "problem pregnancy". Go figure. Fortunately, Mrs Almanian and all kids were fine in the end...

    Again, good luck, and remember: God makes 'em cute so you don't kill 'em. :)

  • Ricky||

    Polycystic ovary syndrome (PCOS) is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain etiology, but there is strong evidence that it can to a large degree be classified as a genetic disease.

    http://en.wikipedia.org/wiki/P.....y_syndrome

  • DrC||

    sure genetic component. but not a mutation that would lead to a so called birth defect. genetically inherited like type 2 diabetes or some types of heart disease.

  • DrC||

    My Wife is preggers with our first IVF love child. She has poly cystic ovarian syndrome. Doubt some chromosomal abnormality. But the process seems to not insure survival of the fittest. I'll take 4% risk. We have been trying for almost 3 years and finally are pregnant. The infertility industry is driven mostly by private paying or very good insurance. I suspect the government wants to get its filthy hands on this industry. next they will come up with some other junk science regarding other profitable private pay health care industries such as lasik.

  • LarryA||

    We need to be sure that long-term monitoring of children born by means of infertility treatment is routine and that more research is done into the causes of health problems for kids who cannot make choices about facing risk.

    Given that the choice is 1% higher risk of birth defects, or not being born, I think I can guess which choice a rational kid would make.

  • BMFPitt||

    At least aside from couples carrying genes that would make being born the less desirable option.

  • Almanian's Evil Twin||

    We really need to do something. For the children.

  • Bill||

    The only reason Caplan is around is to scare people and preach about this kind of shit. That's what bioethicists do.

  • Mickey Rat||

    In the past, Bailey has argued that if a great enough percentage of an age cohort of human individuals dies of natural causes then it is ethical to intentionally kill them. Forgive me if I dismiss his opinions on ethics out of hand.

  • Doug D.||

    I haven't read the original article, but unless they controlled for maternal age the 1% is pretty meaningless. Most "spontaneous" mothers are younger than IVF mothers, because the journey to IVF is long and most people try for several years before getting to the IVF point. I can say as the father of an IVF baby, the 1% wouldn't have made any difference.

  • ||

    Well this changes everything. I wish my parents had never taken the huge risk of conceiving me through IVF.

  • joy||

    What does a 37 percent increase in birth defects among IVF babies represent? Basically, it means that the researchers found that 4 out of 100 IVF babies are born with birth defects. http://www.nikewinkel.com/scho.....-c-30.html That is not nothing, but it sure does sound less scary than a 37 percent increase.

  • Bill||

    Also, there should be error bars on those numbers. 3% +/- 0.5% and 4% +/- 0.5% could be statistically insignificant.

  • Corey Whelan||

    Great article Ronald. You would have sold a book today if I could have downloaded it to kindle.
    best,
    Corey Whelan

  • janvones||

    Talk about a false alternative! The question isn't whether to go in vitro or to go natural; it's whether to go in vitro or not at all. This is a treatment for infertility, not a scheduling preference.

    Children who aren't conceived at all rarely suffer birth defects. They never even die. Does that make not being born the best way to live?

  • دردشه عراقية||

    Thanks

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