Louise Brown, the
world's first 'test-tube' baby, is shown
shortly after she was born at Oldham General
Hospital in England on July 25, 1978.
Do IVF kids face
more health risks?
Panel to sort
through studies, offer guidance to parents
By Jacqueline
Stenson
MSNBC CONTRIBUTOR
July 21 — In
the 25 years since the birth of the world’s first “test-tube” baby,
about a million children around the globe have been conceived with
the help of medical technology, and experts say most of them are
doing just fine. But with a growing number of studies suggesting
these kids may have elevated rates of rare birth defects or other
health problems, U.S. doctors have formed a panel to take a careful
look at the safety of fertility techniques.
BORN IN ENGLAND on July
25, 1978, Louise Brown was the first child to be conceived through
in vitro fertilization. Since then, assisted reproductive
technology, or ART, has become more common with thousands of
children born each year. In 2000, the latest year for which
statistics are available, about 35,000 babies in the United States
were born using ART, accounting for 1 percent of all U.S. births.
Studies have yielded conflicting results on the safety of
these techniques, with some reports showing that children conceived
through ART are no different health-wise than their naturally
conceived peers while other studies have raised concerns.
“What we needed was a group of experts to really do an
assessment about the strength and power of the studies and what
conclusions we could reasonably draw about the risks,” says genetics
expert Kathy Hudson, director of the Genetics and Public Policy
Center at Johns Hopkins University in Baltimore and former assistant
director of the National Human Genome Research Institute.
Hudson partnered with the American Society for Reproductive
Medicine and the American Academy of Pediatrics to convene a panel
of experts who are now analyzing the available research.
“Anytime a technique has been associated, even suggested to
be associated, with a problem, I think it’s important to look at
that association to see if it’s real,” says Dr. Sandra Ann Carson,
president of the ASRM and a professor of obstetrics and gynecology
at Baylor College of Medicine in Houston. “Right now, we’re not sure
if it’s real.”
Natural efforts to conceive a child fail for one
in 10 couples, according to the American Society
for Reproductive Medicine. Either the man or the
woman, or occasionally both, can be the source of
infertility problems. But the following medical
techniques can help many couples bear a child:
How it works: With IVF, the most
common type of assisted reproductive
technology, eggs are surgically removed from
the ovaries and fertilized by sperm in a lab
dish. Then the fertilized eggs are
transferred to a woman's uterus. Candidates: Couples who have tried to
conceive for a year with no success,
especially cases where a woman’s fallopian
tubes are blocked or a man has low sperm
counts. Success rate: 23 percent Cost: $7,800 per attempt
How it works: Eggs and sperm (both
known as gametes) are mixed and then
deposited into a woman's fallopian tubes for
fertilization inside the body. Fertilized
eggs then travel to the uterus for
implantation. Candidates: Couples who have tried to
conceive for a year with no success,
especially cases in which a woman does not
have blocked fallopian tubes. Success rate: 28 percent Cost: $6,000 to $10,000 per attempt
How it works: Eggs and sperm are
combined in the laboratory and resulting
zygotes (fertilized eggs) are transferred
into a woman's fallopian tubes. From there,
the fertilized eggs travel to the uterus for
implantation. Candidates: Couples who have tried to
conceive for a year with no success,
especially cases in which a woman does not
have blocked fallopian tubes. Success rate: 24 percent Cost: $8,000 to $10,000 per attempt
How it works: A single sperm is
injected directly into an egg. Fertilized
eggs are then transferred to a woman's
uterus. Candidates: Couples who have tried to
conceive for a year with no success,
especially cases where a man produces very
little or no sperm, or has malformed sperm. Success rate: 24 percent Cost: $10,000 to $12,000 per attempt
The second study by U.S.
health officials showed that children conceived through ART were
more than twice as likely as others to be born underweight (6.5
percent vs. 2.5 percent), putting them at risk for breathing
difficulties and other potentially deadly health problems at birth
as well as developmental difficulties down the line.
Several other studies followed. Last January, two reports
published in genetics journals found that children with
Beckwith-Wiedemann syndrome were four to six times more likely to
have been conceived through IVF or ICSI than not. The syndrome,
which normally affects one in 15,000 newborns, can cause an
oversized tongue and internal organs, high birthweight and a greater
risk of some cancers.
Also in January, a report in The Lancet implicated IVF with a
five- to seven-fold increased risk of a rare form of eye cancer
known as retinoblastoma among children born in the Netherlands.
And, in the April issue of the Journal of Urology, Johns
Hopkins researchers concluded that babies conceived though IVF were
seven times more likely to be born with a set of rare urological
birth defects that include the formation of the bladder outside the
body.
Other case reports linked ICSI with Angelman syndrome, yet
another rare condition that can cause developmental problems and
speech impairment.
To date, there have been about 300 published reports
involving children conceived with ART, says Hudson, and the panel of
experts will be looking at all of them this summer. They plan to
issue a report in the fall with their conclusions and possible
directions for future research.
Britain, too, is taking steps to better understand any
potential dangers to children from these techniques. Last fall, the
government’s Human Fertilization and Embryology Authority and the
Medical Research Council announced the creation of a working group
to explore the issue. The group’s report is expected later this
year.
‘SMALL DIFFERENCES’
While the studies linking ART with health problems may seem
scary, experts emphasize that most of the observed abnormalities are
rare to begin with and therefore are still uncommon even if the risk
is magnified several times.
“You could hypothesize that if there were a particular health
problem that’s very common, it would have been recognized early,”
says Hudson.
“The risks that do exist, if they do exist, are rare,” she
maintains.
Dr. Arnold Strauss, chief of pediatrics at Vanderbilt
University Medical Center in Nashville and a member of the U.S.
panel analyzing the data, agrees.
“Common sense would say that a lot of people have been
through this and most of their children are doing well,” says
Strauss.
“It’s really a question of subtlety and small differences,”
he says.
What is clear is that ART has not produced anywhere near the
catastrophic results some predicted a quarter century ago when Brown
was born.
POSSIBLE FACTORS
Doctors do know that because multiple embryos often are
implanted during an IVF cycle to boost the odds of success, a woman
has an increased risk of having twins, triplets or other multiples.
These babies are at risk for being born prematurely and underweight.
But it’s not known precisely why singletons might be at risk
for low birthweight or some of the various birth defects or other
problems that have been identified in studies.
Advertisement
“Is it
the disease, the infertility, resulting in the birth defect or is it
the technique itself?” asks Carson.
Infertile couples who undergo ART may have characteristics,
such as defective sperm or eggs, that put them at greater risk of
having children with abnormalities, experts speculate.
Strauss said he can see how actual ART procedures could
theoretically pose a risk.
“The speculation would be that you’re dealing with cells that
are put into conditions that they would never normally see,” he
says, referring to egg and sperm cells in a culture medium in a lab
dish. “Cells do change” in culture, he adds.
Experts say potential problems could stem from other aspects
of infertility treatment, including the use of drugs to stimulate
the ovaries or maintain a pregnancy, the freezing and thawing of
embryos, or possible damage to an egg resulting from the injection
of sperm during ICSI.
As fertility specialists sort out the risks, they say parents
of children conceived through ART or those contemplating fertility
treatments should not be overly concerned.
Dr. Zev Rosenwaks, director of the Center for Reproductive
Medicine and Infertility at New York-Presbyterian Hospital in New
York City, says he explains to his patients that ART is still
relatively new and “while we don’t see a glaring increase in the
abnormality rate” there may be some, unclear degree of risk.
Both Rosenwaks and Dr. Alan DeCherney, a professor of
obstetrics and gynecology at the University of California at Los
Angeles and editor of the journal Fertility and Sterility, say their
patients aren’t deterred when they hear about some of the recent
studies.
“They’re interested in getting pregnant,” says DeCherney.
Jacqueline Stenson is a health writer based in Los
Angeles.
DISCLAIMER:
All information, data, and material contained, presented, or provided here
is for general information purposes only and is not to be construed as
reflecting the knowledge or opinions of the publisher, and is not to be
construed or intended as providing medical or legal advice. The decision
whether or not to vaccinate is an important and complex issue and should
be made by you, and you alone, in consultation with your health care
provider.
"A foolish faith in authority is the worst enemy of truth."
-- Albert Einstein, letter to a friend, 1901
"I know of no safe depository of the ultimate powers of the society but the people themselves, and if we think them not enlightened enough to exercise control with a wholesome discretion, the remedy is not to take it from them, but to inform their discretion by education."
-- Thomas Jefferson, letter to William C. Jarvis, September 28, 1820
"What's the point of vaccination if it doesn't protect you from the unvaccinated?"
-- Sandy Gottstein
"Who gets to decide what the greater good is and how many will be sacrificed to it?"
