The Association between Infertility Treatment Modalities and Congenital Anomalies in the United States
Abstract
Introduction and Objective. Assisted reproductive technology (ART), including in vitro fertilization, gamete intrafallopian transfer and non-assisted reproductive technology (fertility-enhancing drugs, artificial insemination, intrauterine insemination), have been associated with increased risks of congenital anomalies in newborns. Yet, there are limited studies comparing these interventions. Our study objective was to compare ART therapies, non-ART therapies, and natural conception regarding the prevalence of selected congenital abnormalities in newborns born to mothers in the United States and to assess if the associations vary according to plurality. Methods. Analysis of data from the 2014-2019 US Natality Data, from the Centers for Disease Control and Prevention. Sample includes all mothers between the ages of 20 and 45 years. Uni-and Multivariable logistic regression analysis was used to estimate the crude and adjusted associations (OR) and corresponding confidence intervals for the association between different infertility treatment and congenital anomalies detected at birth. Effect modification by plurality was assessed with interaction terms added to regression models and stratified analyses performed accordingly. Results. A total of 25,009 newborns were found to have a congenital abnormality (0.24% of all births). For single births, the odds of having a newborn congenital abnormality were higher in women who had ART (OR: 1.40, CI: 1.24-1.59), non-ART (OR: 1.59, CI: 1.38-1.82), or both (OR: 1.48, CI: 1.09-2.00) compared to natural conception. For the plurality of twins or higher, the odds of having a newborn congenital abnormality were higher in women who had ART (OR: 1.38, CI: 1.12-1.71). However, for multiple pregnancies (twins or high plurality) the odds of having a newborn congenital abnormality in women who had non-ART (OR: 1.12, CI: 0.84-1.50) or both (OR: 1.21, CI: 0.70-2.10) were not significantly increased. Conclusions-Implications. The odds of having a congenital abnormality was higher in the ART, non-ART, and groups who used both ART and non-ART fertility treatments. Yet, factors affecting the ability to conceive naturally may contribute to that increase in odds for malformation compared to those who conceive naturally. Additional studies are needed to investigate such hypothesis.
Keywords
infertility, assisted reproductive technology, natural conception, congenital anomalies
Presentation Type
Oral Presentation
The Association between Infertility Treatment Modalities and Congenital Anomalies in the United States
Introduction and Objective. Assisted reproductive technology (ART), including in vitro fertilization, gamete intrafallopian transfer and non-assisted reproductive technology (fertility-enhancing drugs, artificial insemination, intrauterine insemination), have been associated with increased risks of congenital anomalies in newborns. Yet, there are limited studies comparing these interventions. Our study objective was to compare ART therapies, non-ART therapies, and natural conception regarding the prevalence of selected congenital abnormalities in newborns born to mothers in the United States and to assess if the associations vary according to plurality. Methods. Analysis of data from the 2014-2019 US Natality Data, from the Centers for Disease Control and Prevention. Sample includes all mothers between the ages of 20 and 45 years. Uni-and Multivariable logistic regression analysis was used to estimate the crude and adjusted associations (OR) and corresponding confidence intervals for the association between different infertility treatment and congenital anomalies detected at birth. Effect modification by plurality was assessed with interaction terms added to regression models and stratified analyses performed accordingly. Results. A total of 25,009 newborns were found to have a congenital abnormality (0.24% of all births). For single births, the odds of having a newborn congenital abnormality were higher in women who had ART (OR: 1.40, CI: 1.24-1.59), non-ART (OR: 1.59, CI: 1.38-1.82), or both (OR: 1.48, CI: 1.09-2.00) compared to natural conception. For the plurality of twins or higher, the odds of having a newborn congenital abnormality were higher in women who had ART (OR: 1.38, CI: 1.12-1.71). However, for multiple pregnancies (twins or high plurality) the odds of having a newborn congenital abnormality in women who had non-ART (OR: 1.12, CI: 0.84-1.50) or both (OR: 1.21, CI: 0.70-2.10) were not significantly increased. Conclusions-Implications. The odds of having a congenital abnormality was higher in the ART, non-ART, and groups who used both ART and non-ART fertility treatments. Yet, factors affecting the ability to conceive naturally may contribute to that increase in odds for malformation compared to those who conceive naturally. Additional studies are needed to investigate such hypothesis.