Seminars in Fetal & Neonatal Medicine xxx (2014) 1

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Editorial

Assisted reproductive technologies: Impact on fetal and neonatal outcomes Following the birth of the first ‘test tube’ baby in 1978, in-vitro fertilization (IVF) and associated assisted reproductive technologies (ART) have become part of routine clinical care for the treatment of infertility. Early concerns about the health of children born following ART were raised, although the first outcome studies were generally poorly designed and too small to detect real effects. A body of research has subsequently been conducted which provides some of the answers concerning the health effects for the children conceived by ART. This special edition of Seminars in Fetal and Neonatal Medicine is devoted to reviewing this evidence. The single most important influence on child health following ART arises from the increased chance of being part of a multiple pregnancy following transfer of more than one embryo. Murray and Norman describe the maternal and perinatal health effects of multiple pregnancy and also the methods used to reduce these risks including elective single embryo transfer (eSET). Hansen and Bower describe and quantify the risks of low birth weight, preterm birth, small for gestational age and birth defects associated with being born following ART. Aaris Henningsen and Pinborg discuss the evidence suggesting that perinatal outcomes for IVF babies are improving. The two papers by Källén, and Abdel-Mannan and Sutcliffe, look to the long-term developmental consequences. Källén concludes that ART is associated with some specific adverse developmental and health consequences, whereas Abdel-Mannan and Sutcliffe conclude that in comparison to birth weight, gestational age, socio-economic status, and parental educational levels, ART appears to have a minimal effect on cognitive function. Kurinczuk and Bhattacharya consider the rarer genetic, chromosomal, and imprinting-related risks. Chambers and Ledger continue the multiple birth theme by examining the economic implications of multiple pregnancy and the cost-effectiveness of eSET. A consistent but as yet unresolved theme running through the papers in this edition is the extent to which adverse outcomes

are due to ART or are a consequence of the infertility itself. There have been analytical attempts to disentangle these effects, as described by Källén, and Aaris Henningsen and Pinborg. Whereas it may be reassuring to know that current evidence suggests that ART techniques are responsible for perhaps only a small part of the risk of adverse outcomes, this is in a sense a moot point for the majority of couples since they will inevitably experience the combined effects of both their infertility and its treatment. It is not entirely clear the extent to which couples are fully advised of the risks ahead of treatment, nor whether this would have any effect on their treatment choices. Recently introduced aspects of ART may also be associated with new problems; the effects of embryo transfer at the later blastocyst stage and rapid embryo freezing techniques (vitrification) have yet to be elucidated fully in the face of the early concerns discussed by Aaris Henningsen and Pinborg. Finally, as long-term impact of epigenetic changes may not become apparent for many years, there is a need for long-term follow-up of ART-conceived children. Jennifer J. Kurinczuk* National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK Siladitya Bhattacharya Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK * Corresponding

author. National Perinatal Epidemiology Unit, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK. Tel.: þ44 (0) 1865 289719. E-mail address: [email protected] (J.J. Kurinczuk).

http://dx.doi.org/10.1016/j.siny.2014.04.006 1744-165X/Ó 2014 Elsevier Ltd. All rights reserved.

Please cite this article in press as: Kurinczuk JJ, Bhattacharya S, Assisted reproductive technologies: Impact on fetal and neonatal outcomes, Seminars in Fetal & Neonatal Medicine (2014), http://dx.doi.org/10.1016/j.siny.2014.04.006

Assisted reproductive technologies: impact on fetal and neonatal outcomes.

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