Attachment Parenting, Same sex-marriage, birth defects and IVF? A busy week for Women's Health
WOW! what a busy week last week was on many fronts that probably captured the attention of many in women's health: new TIME magazine cover, NEJM article about birth defects and IVF, and president Obama's announcement regarding his position on same-sex marriage.
I will focus my attention by commenting on the NEJM article. Using birth registry data from Southern Australia, the authors compared an infertile population to a normal fertile population and show that there is a 8.3% birth defect rate among those women treated for infertility (5.8% in the "normally" conceiving population." In any cohort study confounders must be controlled for and here the authors do this but some have argued that when differences between the populations (one infertile and one fertile) are too great djusting for confounders is not enough.
The one, perhaps simple finding that I gravitate towards is the % of birth defects among those undergoing IVF (105/1484=7.1%), IVF+ICSI (91/939=9.7%), and history of infertility with no history of any ART (52/600=8.7%) VS those who had a spontaneous conception (5.8%) - reinforces to that it is the underlying infertility, and perhaps the older population of the infertility cohort and not the treatments that may be responsible.
Eitherway, the article's findings suggest that there are subtle associations between infertility treatments and birth defects. Remember, that in these cohort studies, association does not confirm causation. While their findings should not be ignored, their work highlights a topic that is already discussed in infertility clinics worldwide.Their findings reinforce the conventional wisdom that it is the underlying infertility and not the treatments that are leading to the increase in birth defects.
But don't take my word for it here is the official response from the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART):
WOW! what a busy week last week was on many fronts that probably captured the attention of many in women's health: new TIME magazine cover, NEJM article about birth defects and IVF, and president Obama's announcement regarding his position on same-sex marriage.
I will focus my attention by commenting on the NEJM article. Using birth registry data from Southern Australia, the authors compared an infertile population to a normal fertile population and show that there is a 8.3% birth defect rate among those women treated for infertility (5.8% in the "normally" conceiving population." In any cohort study confounders must be controlled for and here the authors do this but some have argued that when differences between the populations (one infertile and one fertile) are too great djusting for confounders is not enough.
The one, perhaps simple finding that I gravitate towards is the % of birth defects among those undergoing IVF (105/1484=7.1%), IVF+ICSI (91/939=9.7%), and history of infertility with no history of any ART (52/600=8.7%) VS those who had a spontaneous conception (5.8%) - reinforces to that it is the underlying infertility, and perhaps the older population of the infertility cohort and not the treatments that may be responsible.
Eitherway, the article's findings suggest that there are subtle associations between infertility treatments and birth defects. Remember, that in these cohort studies, association does not confirm causation. While their findings should not be ignored, their work highlights a topic that is already discussed in infertility clinics worldwide.Their findings reinforce the conventional wisdom that it is the underlying infertility and not the treatments that are leading to the increase in birth defects.
But don't take my word for it here is the official response from the American Society of Reproductive Medicine (ASRM) and the Society for Assisted Reproductive Technology (SART):
A
paper published today in the New England Journal of Medicine noted an increased
incidence of birth defects in ART-conceived children. ASRM and SART
responded.
Statement
Attributable to Linda Giudice MD, PhD, President-elect of the American Society
for Reproductive Medicine (ASRM):
“This
study confirms what has been known for quite some time: Patients who need
medical assistance to conceive have a somewhat higher risk of having children
with birth defects than parents able to conceive on their own. Patients
considering medically assisted conception have been, and should continue to be,
counseled on those risks prior to undergoing any treatment.”
Statement
attributable to Glenn Schattman, MD, President of the Society for Assisted
Reproductive Technology (SART):
“It
is important to note that women with a history of infertility who did not
undergo ART treatments also had a higher increase of having children with birth
defects. This combined with the finding that those using ICSI (Intra
Cytoplasmic Sperm Injection) also had slightly elevated risks of birth defects
suggest that the underlying problem that led them to seek medical
assistance in the first place is likely contributing to the elevated risk of
birth defects in their children.
Some
results in this study are reassuring for patients: in cycles not including
ICSI, the adjusted odds ratio for IVF conceived children did NOT show a
significant difference in birth defects children born following embryo freezing
had no higher risk of birth defects than naturally conceived children.
These
are interesting and important findings and we will need much more research to
allow us to help patients overcome their infertility with treatments that are
as safe as possible for them and the children born from the treatments.”
Please comment, but keep it civil.
It is true that ratio of birth defects in children born through ivf treatment is higher than normal babies.
ReplyDeleteicsi treatment
yes...but as pointed out by ASRM's president LInda Guidice, the underlying infertility that requires treatment puts these women at risk, not necessarily the treatment per se. Case in point, the group of patients in the study quoted in my post that had infertility BUT did not receive IVF also had a higher rate of birth defects compared to "normal" fertile controls....all in all patients are counseled on this risk but it is so small that it typically does not discourage those who desire a child.
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