The long-term paediatric outcomes of assisted reproductive therapies

Introduction: In vitro fertilisation has just celebrated its 25th anniversary and there have been a number of further advances since then such as intracytoplasmic sperm injection (ICSI). Few centres have established systematic outcome follow-up of children thus conceived. Herein is a review of what is known about the longer-term outcomes of assisted reproductive therapies (ART). Methods: In essence, the main, and most important, cause of longer-term problems after assisted reproductive therapies remains preventable. This is a result of twin and higher-order births and prematurity. Longer-term outcomes can be considered in terms of neurodevelopmental well being, physical development and growth and in terms of emerging concerns about these children. In addition, the literature is described in summary form taking into account categories of ART-conceived children, such as those conceived after standard in vitro fertilisation, embryo cryopreservation and intracytoplasmic sperm injection. Results: The balance of evidence shows that when born mature, children born after ART are no different neurodevelopmentally than their naturally conceived peers. In physical terms, they appear to be healthy apart from their risks of congenital anomalies, which are described elsewhere. However, there is early evidence to suggest there may be more unusually tall children and this topic needs to be carefully investigated. In addition, then. are long-term further concerns about these children, which can be described, in essence, their future fertility, their long-term risk of cancer and imprintable disorders. Future fertility will be an extremely difficult question to answer because of the confidential nature of this. There are emerging reports that suggest there is a higher risk of imprintable disorders in these children, such as Beckwith-Weidemann syndrome. This may also have implications for childhood cancer and there is one report suggesting a higher risk of retinoblastoma. Conclusions: These matters need to be fully investigated with a robust study. When these children grow up, they will become a significant group and will have a different view of the justification for using fertility methods for them to be conceived than those who were involved in the treatment process in the first place. We all need to be attentive to supporting studies, which try to follow these children into adult life. (C) 2004 Published by Elsevier B.V.