IVF and birth defects

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An interesting article from Time magazine on IVF and possibly related birth defects. In my opinion this is going to be the next scandal akin to Thalidomide. We don't yet understand te full complexity of gene expression during development and we didn't take into account epigenetic markers such as methylation that are added during in vivo growth of the egg. Article from Time here and text from article below:

In vitro fertilization (IVF) is responsible for creating thousands of happy
families, but the latest research highlights some of the potential long term
risks of the procedure.


The role infertility treatments play in birth defect risk isn’t fully
understood, and whether it’s the in vitro fertilization (IVF) procedures or
infertility itself that bears the greatest influence remains up for debate.


Researchers presenting at the American Academy of Pediatrics (AAP) National
Conference and Exhibition in New Orleans report that IVF may significantly
increase birth defect risk, especially in the heart, eyes, reproductive organs
and urinary systems, among children born through the technique.





In their study, scientists at the University of California, Los Angeles (UCLA) looked at birth defects among
infants born both via IVF and conceived through natural means in California,
which has the country’s highest rate of IVF use. They included babies born
after IVF and other assisted reproductive treatments such as couples’ use of
fertility-enhancing drugs and artificial insemination.



Among 4795 babies born after IVF and 46,025 infants who were conceived
naturally, 3,463 babies had congenital birth defects. Even after controlling
for factors that can affect such birth defects, such as mother’s age, and race,
which can influence rates of genetic and environmentally driven developmental
disorders, 9% of infants born after IVF had birth defects compared to 6.6% of
babies who were conceived naturally. Overall, the babies born after IVF were
1.25 times more likely to be born with abnormalities. The researchers did not
find a link between birth defects and other fertility treatments like
artificial insemination or ovulation induction.


It’s possible that the higher rate of abnormalities with IVF is due in part
to whatever was contributing to infertility in the first place, say the
researchers. But the fact that an increase was not seen among babies conceived
using artificial insemination or ovulation induction suggests that process of
IVF itself, in which eggs are removed from a woman, fertilized in a dish with
sperm and then allowed to develop into embryos, which are transplanted back
into the womb, is the primary culprit.


“For parents considering in vitro fertilization or other forms of assisted
reproductive technology, it is important that they understand and discuss with
their doctor the potential risks of the procedure before making a decision,”
said lead study author Dr. Lorraine Kelley-Quon, a general surgery resident at
at Ronald
Reagan UCLA Medical Center, in a statement.



An earlier study in the New
England Journal of Medicine also reported a link between fertility
treatments and a higher risk of birth defects, but risk varied greatly by
procedure. In that study, IVF was not associated with birth defects, but other
procedures such as intracytoplasmic sperm injection (ICSI) and ovulation
stimulation medications were. They also reported that frozen embryos created
through IVF were less likely to result in babies with birth defects than fresh
embryos.





Despite the fact that more than four million babies have been born using IVF,
and the first ones are just reaching reproductive age, it’s clear that some of
the long term effects of IVF and other assisted reproductive techniques still
aren’t well understood.


Even so, the American Society for Reproductive Medicine (ASRM) is taking an
important step regarding another infertility treatment by announcing that egg
freezing should no longer be considered an “experimental” treatment for couples
unable to conceive naturally. The decision is based on a report developed an
ASRM committee and the Society for Assisted Reproductive Technology (SART).
After reviewing nearly 1,000 cases of egg freezing, the committee members found
that the chances of getting pregnant via IVF were comparable using both fresh
and frozen eggs. They also found no increases in birth defects, chromosomal
abnormalities and developmental disorders among babies born using frozen eggs.
In most cases, women take hormones to in order to release several mature eggs
at a time, and these are surgically collected and fertilized as soon as
possible. But because the number of eggs generated with each such ovulation
cycle varies, some women chose to freeze eggs from a particularly successful
cycle so they can be fertilized at a later date.


“I think this will really allow so many more women greater options for family
building, which is terrific,” says lead study author Dr. Samantha Pfeifer of
the University of Pennsylvania. Successful IVF, for example, requires an
adequate supply of sperm to be available when a woman’s eggs are retrieved, and
sometimes that’s not possible. Freezing eggs means the eggs can be thawed
whenever that robust supply of sperm is available. It’s also an option for
couples who aren’t comfortable freezing embryos, which some see as the earliest
form of life. “Now they have this as an option,” says Pfeifer.

Lifting the “experimental” classification for egg freezing could also push
insurers to cover the expensive procedure, which they currently do not
reimburse for infertility treatment (some cover egg freezing costs for women
being treated for reproductive cancers). “Insurance companies should have
coverage for it and I think more programs are going to be offering this
technique. It allows patients to have greater access to the procedure,” says
Pfeifer.





However, she warns that it’s too early to tell if the rate of developmental
anomalies among babies born from frozen eggs is similar to children born from
frozen embryos. Although it appears to be a safe procedure, more long-term
research is needed before it’s routinely used. The ASRM is also not advising
healthy women without infertility problems to freeze their eggs for future
use.