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expert reaction to an study looking at rates of congenital heart defects in children born via IVF/ICSI and spontaneous conception

Scientists publishing in Ultrasound in Obstetrics and Gynecology report that foetuses conceived with IVF/ICSI methods are at an increased risk of congenital heart defects, compared to spontaneous conceptions.

 

Prof. Adam Balen, Chairperson, British Fertility Society said:

“This paper looks at what is in the literature already and by bringing together multiple sources of data, they have sought to draw conclusions.

“The fact that they find a potential link between assisted reproductive technologies and congenital heart defects is certainly interesting but it warrants further investigation before any firm conclusions could be drawn.

“There could be many reasons for this correlation – for example, people undergoing treatment for infertility are often older – and until all variables can be controlled for, all we can do is say that there might be an association.

“At this stage, this is certainly not something that would change my practices or the way my team cares for patients.

“We also advise that all women wishing to conceive either naturally or with assistance should be taking 400mcg of folic acid daily and if they are overweight this should be increased to 5mg daily in order to improve the prospects of having a healthy baby.”

 

Dr Katie Morris, Senior Clinical Lecturer and Consultant Maternal Fetal Medicine, University of Birmingham, said:

“This is a large systematic review and meta-analysis of observational data comparing the occurrence of congenital heart defects in women conceiving spontaneously compared to women who conceive through two different types of artificial technique (IVF/ICSI).

“It is already known that pregnancies conceived by these techniques have an increased risk of congenital abnormalities including those of the heart. This study aims to quantify this risk further and look at other factors that might influence the risk e.g. maternal age or type of heart defect.

While the increased risk is confirmed overall, the authors have found that this is mainly for types of congenital heart differences that would not necessarily be found by a routine scan looking at the baby’s heart in detail in the womb (such as holes within the muscle of the heart). Also all of the studies used scans to look for heart differences in a variable way e.g. time, experience of person performing the scan and the detail they looked for. This data while confirming the increased risk for these pregnancies does not support a policy in the UK of offering all women conceiving after these techniques a special heart scan (fetal echocardiogram) for their baby.”

 

Dr Katie Morris, Senior Clinical Lecturer and Consultant Maternal Fetal Medicine, University of Birmingham, said:

“This is a large systematic review and meta-analysis of observational data comparing the occurrence of congenital heart defects in women conceiving spontaneously compared to women who conceive through two different types of artificial technique (IVF/ICSI).

“It is already known that pregnancies conceived by these techniques have an increased risk of congenital abnormalities including those of the heart. This study aims to quantify this risk further and look at other factors that might influence the risk e.g. maternal age or type of heart defect.

“While the increased risk is confirmed overall, the authors have found that this is mainly for types of congenital heart differences that would not necessarily be found by a routine scan looking at the baby’s heart in detail in the womb (such as holes within the muscle of the heart). Also all of the studies used scans to look for heart differences in a variable way e.g. time, experience of person performing the scan and the detail they looked for. This data while confirming the increased risk for these pregnancies does not support a policy in the UK of offering all women conceiving after these techniques a special heart scan (fetal echocardiogram) for their baby.”

 

Prof. Alastair Sutcliffe, Professor of General Paediatrics, UCL, said:

“The old chestnut beloved of the press, and the fertility specialists/ embryologists has appeared again. Do or do not children born after ART (assisted reproductive therapies) have higher rates of congenital anomalies than naturally conceived children?

“A number of good quality systematic reviews have been done, all concurring broadly that the rate of congenital anomalies is circa 1.3 x background, often reported as a 30% increase causing alarm to the growing numbers of parents (2% and rising in the UK, up to 5% in France and Denmark ) who have the joy of parenthood by this method of conception.

“So what does the study reported by this Italian group add? A suggestion that there are more congenital heart defects in this group of children. Is it plausible that this particular group of defects might be more common…I think not. Is it plausible this is more of the same, I think yes.

“The root of all congenital anomalies in ART conception is overbearingly not method, but more why were the coupe sub fertile in the first place?

“This report reinforces the need for systematic health monitoring and parents will welcome that.”

 

* ‘Congenital heart defects in IVF/ICSI pregnancy: a systematic review and meta-analysis’ by Veronica Giorgione et al. published in Ultrasound in Obstetrics and Gynecology on Wednesday 22nd November.

 

All our previous output on this subject can be seen at this weblink: http://www.sciencemediacentre.org/tag/ivf/

 

Declared interests

Dr Katie Morris: ‘No conflicts of interest.’

None others received.

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