Do IVF kids face more health risks? - Panel to sort through studies, offer guidance to parents

Return to Vaccination News Home Page __» Right-click to "open in new window"

Subscribe to the Vaccination NewsLetter

View past & current Scandals (columns by Sandy Mintz)

http://www.msnbc.com/news/940303.asp?0cv=HA01

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.

	•	Do IVF kids face more health risks?

	•	Looking ahead: The future of babymaking

	•	Birds and bees for 'test-tube' kids

	•	Slide show: Meet an 'in vitro family'

	•	Ethics: 'Test-tube' babies vs. clones

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

Printable version

SUSPECTED PROBLEMS
During IVF, doctors place egg and sperm cells together in a petri dish and then transfer one or more of the resulting fertilized embryos into a woman’s uterus. With intracytoplasmic sperm injection, or ICSI, a modification of IVF that was developed in the early 90s to overcome male factor infertility, doctors inject a single sperm — which may be immobile or misshapen — into an egg.
Among the more recent reports that have triggered some alarm over the techniques are two large-scale studies published in The New England Journal of Medicine over a year ago.
One study conducted in Australia found that babies conceived through IVF or ICSI were more than twice as likely as naturally conceived infants to have major birth defects (9 percent vs. 4.2 percent), including problems with the heart and urinary or genital tracts.

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.

“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.

Return to Vaccination News Home Page __» Right-click to "open in new window"

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.