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EDUCATION

IVF and Autism

By August 27, 2013 April 3rd, 2020 No Comments

Words: dr Gary swift

Recently medical media attention has focused on a study of neurodevelopmental outcome of children conceived with assisted reproductive technologies. Headlines have focused on sensationalism as per usual and have left the facts to be deciphered in the fine print.

In Australia and most developed countries, 15% of couples don’t conceive easily and require assisted reproductive technologies (ArT), which includes IVF and various associated techniques to achieve pregnancies. Since even before the first IVF baby, Louise Brown, was born in 1978, there was concern that IVF was interfering with nature and may cause more harm than good.

Thankfully, history has shown that much more good has resulted than harm, with only a slight overall increase in birth defects and mostly minor. Many beautiful healthy babies have been born who might not otherwise have existed without these technological advances. Many are now adults and having their own children.

It is true that as IVF doctors we are ‘interfering’ with nature. Most facets of medicine are, after all, altering the natural course of disease, preventing premature death and improving quality of life, where possible. In the Assisted reproductive Technology arena, it means assisting couples who would not otherwise have children to be parents. This implies taking some risk.

The study in question which raised concern was published in the Journal of the American Medical Association (JAMA) in July 2013. The authors used Swedish medical data to analyse more than 2.5 million birth records and subsequent paediatric assessments between 1982 and 2007. Specifically the researchers were looking at

the incidence of autism (a global neurodevelopmental abnormality) and intellectual disability related to various IVF techniques.

overall, there was no increased incidence when all IVF techniques were grouped together, however, when they isolated specific procedures, there was an increase in children born as a result of Intracytoplasmic sperm injection (ICSI), where a single sperm is isolated and injected into each egg, and more so with testicular sperm extraction (TeSe).

ICSI is required for couples when the male semen parameters (concentration, motility and morphology) are compromised or if egg fertilisation has failed previously or is likely to fail due to certain conditions. Testicular sperm extraction is required after vasectomies if the reversal has failed or the time interval is significant and in some disorders of genetic origin and when the tubes carrying the sperm (Vas Deferens) don’t form properly.

The absolute risk of neurodevelopmental problems is still incredibly low (93 per 100,000 births after ICSI and 136 per 100,000 births after TeSe). The study tells us that

we need to specifically look at when to use procedures and to be constantly aware of any potential impact. The results don’t in any way suggest the technology shouldn’t be offered to couples who require it, just used carefully and appropriately when it is indicated.

As with all areas of infertility, and IVF related technologies each couple has a unique combination of factors and are counseled exhaustively about procedures and risks and the current state of research. Doctors and nurses are there to answer any concerns. It is best to discuss personally issues which may affect you rather than be alarmed unnecessarily by specific data interpretation.

Dr Gary Swift is an obstetrician & Gynaecologist with a Masters degree in reproductive Medicine. he specialises in infertility and IVF as a senior specialist at the Queensland Fertility Group Gold Coast Unit at Pindara hospital. he is available to evaluate, guide and discuss all matters for couples related to fertility management and IVF technologies

More at www.drgaryswift.com.au

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