Adolescents who were conceived using assisted reproductive techniques, such as in-vitro fertilization (IVF), do not appear to be at risk of poor psychiatric health compared with the general population, except for a slightly elevated risk of obsessive-compulsive disorder (OCD), according to a report published today in JAMA Psychiatry.
“Overall, we found that adolescents conceived with [assisted reproductive techniques] had a slightly higher risk of anxiety and antidepressant use but a lower risk of mood disorder and suicidal behavior compared with all other children. Importantly, the observed differences in risk were explained by differences in parental characteristics, including the underlying infertility, rather than the [assisted reproductive techniques] intervention itself,” wrote Chen Wang, M.P.H., of the Karolinska Institutet in Sweden and colleagues.
Assisted reproductive techniques have resulted in more than 9 million births worldwide. However, studies indicate that infants conceived through these techniques are also more likely to be born preterm, have low birth weight, and/or have birth defects compared with spontaneously conceived children. These perinatal complications have been linked to neurocognitive development impairment and mental health problems later in life.
Using Swedish national birth registries, the researchers analyzed data on more than 1.2 million children born between January 1, 1994, and December 31, 2006. Follow-up was completed on December 31, 2018, when participants were 12 to 25 years of age. They compared psychiatric outcomes among children conceived using assisted reproductive techniques with those conceived spontaneously. Clinical diagnoses of mood disorder, including major depression, anxiety, OCD, and/or suicidal behavior, were identified from hospital records and outpatient specialist care. Suicide was identified from death certificates.
A total of 31,565 children (2.6%) were conceived with assisted reproductive techniques. These youth had a 1.35 times higher risk of OCD than youth conceived spontaneously, but the risk was lower (1.10 times higher risk) when adjusting for parental demographics, maternal health conditions, and parental psychiatric conditions. When the comparison was restricted to children of parents with known infertility, however, the children conceived with assisted reproductive techniques were at no greater risk of OCD compared with the others.
Among children born to those without infertility, the estimated incidence of anxiety, attempted or completed suicide, and antidepressant use was 5.6%, 0.9%, and 7.0%, respectively. Among children conceived with assisted reproductive techniques, the corresponding cumulative incidences were comparable or lower across all ages.
Fresh but not frozen embryo transfer was associated with a lower risk of mood disorders when compared with children of parents with infertility who conceived without assisted reproductive techniques, making frozen embryo transfer appear less advantageous in direct comparison with fresh embryo transfer.
“[T]he findings were reassuring with respect to the psychiatric health of adolescents conceived with [assisted reproductive techniques],” Wang and colleagues concluded. “An elevated risk of OCD in the overall comparison with all other adolescents may be explained by differences in parental characteristics, and parental use of [assisted reproductive techniques] could be a candidate in potential screening of this disorder.”
For related information, see the American Journal of Psychiatry article “Psychiatric Aspects of Infertility.”
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