Ivf
 

I'm taking an informal poll. Do you know children who were conceived via in vitro fertilization, and if so, are they as healthy and normal-sized as children conceived the old-fashioned way?

I'm asking because after trying everything else both Western and Eastern medicine have to offer, ivf seems to be our only remaining option for my husband and I to have our own biological children.

The doctors I've asked all say IVF kids are of comparable size and health, the only difference is how and where the fertilization process took place. I'm not aware of any long-term studies on the health of IVF-conceived babies. But of the three couples I personally know to have conceived this way, the kids seem to be either very small for their age or have health problems. Obviously, this sample is too small to mean anything, so any insight would be appreciated.

Thanks,
Ally

IVF
 

Weddingchannel.com hosts a number of wedding, newlywed and family planning message board sites, including one on IVF.

(WeddingChannel Message Board > Newlyweds > Group Threads -- All Topics > IVF Support)

I'm sure that you'll find all of the answers you're looking for (and then some).

Ivf
 

There are studies that looked at this. If you know how to use a search engine, you can look them up in Pubmed here:

http://www4.ncbi.nlm.nih.gov/PubMed/

Then either order them online, or go to a medical library or call a medical library and you can get copies for a fee. Your firm's librarian may be able to help you get copies.

My understanding is that the most important determinant of developmental outcome in IVF births is whether it is a multiple gestation or not. Even just having twins results in an increased risk of adverse long term developmental outcomes. But this is true of non-IVF births.

In some European countries with socialized medicine systems, they have registries that track IVF pregnancies and have amassed some data.

The good news is that they have much better ways to determine the viability of the fertilized egg now and don't transfer as many now a days.

The best advice I can give you is to use a fertility clinic with a high success rate and a low multiple birth rate. There are plenty of online support groups that deal with assisted fertilization. You will find many educated and informed men and women on these boards and they can help to educate you about how to research the quality of the clinics. Some clinics still use out of date technology and transfer far too many fertilized eggs at one time. Go to one of the high quality clinics that use the state of the art techniques for assessing the quality of the fertilized eggs. These clinics have high success rates without having high multiple birth rates.

I cannot emphasize enough how important it is to research the doctor and the clinic. Board certified doesn't mean competent, unfortunately.

These are links to the abstracts of some of the studies on IVF babies that have been done. If you don't know how to evaluate the quality of a medical study, you should take the studies to your doctor and ask them to help you to understand them. As I stated above, one explanation for differences seen in IVF children are due to multiple gestations. The more kids you have at one time the riskier it is for low birth weight and permaturity, but that is not caused by the IVF procedure, just by the number of fertilized eggs transferred. Other differences could be due to advanced maternal age, since on average, these IVF babies are born to mothers who are older than mothers of non-IVF babies. Studies that don't control for multiple gestations and maternal age are worthless.

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11882727
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11938478
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=10407596
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11844355
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12470533
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14585883
http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=8921089
http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=8628608
http://www.ncbi.nlm.nih.gov/entrez/q...t_uids=9789191

This study looked at ICSI (intra-cytoplasmic sperm injection), which is only done if the male's sperm cannot fertilize without being injected directly into the egg:

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14507822

These studies looked at ICSI vs. conventional IVF and/or natural conception:

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=12571172
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14667874

If they cannot find a cause for your infertility, although you may not want to hear this, it could be an indication of a genetic problem with your eggs or your husband's sperm or the combination thereof. While there are some genetic problems that can be tested for, there are likely far more that medical science has yet to discover let alone develop a test for. They can do pre-implantation genetic testing, but of course, can only test for those genetic problems that are known and that they have a test for.

Ivf
 

Yes, and yes. My partner doesn't want me to do it the old fashioned way, so, in two to three years we'll probably be doing in vitro.

Ivf
 

this is objectionable?

http://www.surlatable.com/images/pro...9953_4603z.jpg

:D

Ivf
 

Ally, we have friends who have had children via IVF. The twin boys are seven years old and healthy since day one. Go for it.

Ivf
 

I know a lot of kids who became possible by IVF and other fertility treatments. I've got twins, and we know a lot of twins through the local parents of multiples club. Most members of the club had multiples as the result of fertility treatments of one sort or another, mostly IVF.

The kids I know run the entire range of health and size. However, I have two observations, one statistical and one anecdotal.

Anecdotally, it seems like the naturally conceived children that are friends with the baltspawn seem on average to be healthier and bigger. There may be only an issue of correlation rather than causation, however, in that the children that seem less healthy were also born more prematurely, and it is the premature birth that contributes to the health problems. I don't think the premature births are the result of IVF, but may be influenced by other factors that also lead to IVF (age of the mother, health of the mother, etc.). And again, the IVF kids run the entire range. I would characterize very few as having significant health or developmental problems.

Statistically, IVF leads to much (much!) higher incidents of multiple births, and statistically multiple birth children are on average smaller and more prone to significant health issues than singletons. So there is some correlation, but it isn't necessarily such a high risk factor that you should walk away from IVF.

There is a lot of materials out there, and many people who have successfully conceived through IVF love to talk about it -- indeed, we have a couple of play date friends that won't shut up about it. (Nonetheless, some people don't want to talk about it at all, and it is considered rude to ask parents of twins if they had IVF - I'm just saying if you find somebody who did it, they may be quite willing to talk).

Best wishes in making your decision.

Ivf
 

Quite. Now there is all this fancy, technical equipment.


Come to think of it, the people I know who have done in vitro, as opposed to the people most of you know, would have undergone in vitro for a different reason. So there is a causation question. It would be very interesting to see a study about the health and birth size of children when people who had no fertility issues used in vitro compared to those who had fertility issues and used it.

IVF
 

Yes I know several IVF children, they seem to be very healthy, and except for the twins, they seem of normal size. Mr. Lex's boss has twins and a singleton which are all IVF and they are adorable and healthy. Without technology she wouldn't have been able to have any of them and even if they were a bit on the small side (they weren't) it would have been well worth it.

The only comment (and I agree with Baltassoc re health of mother, etc...) I have is that there have been some recent studies showing increased health problems - presumably from weak egg or sperm that wouldn't have "made it" but for IVF assistance. Even then, the risk is minimal, due in large part to multiples, and, from the evidence I have seen well worth the small risk.

Do, however, be sure you go to a very reputable Dr. so you don't end up with octuplets! The more reputable Drs will only implant say 2 or three embryos.

www.webmd.com has message boards on the subject and ivillage.com/parentplace.com has articles and other info.

I have gone through some of this myself, though not to the point of IVF - and did all the research for myself and a couple friends. Feel free to pm me.

OTOH, if you are interested in adoption, Vietmom is a wealth of knowledge on the subject.

-TL

IVF
 

Ally, PM me if you want to talk about this more--we're looking at IVF in the next couple of months if I'm not pregnant now (after injectable drugs and an IUI).

tm

Ivf
 

Yes, that would be interesting. It may help to explain studies like this one using the Australian registry data which showed that, even when they controlled for maternal age, singleton births from IVF or ICSI had a higher incidence of major birth defects than singleton naturally conceived children.

http://www.ncbi.nlm.nih.gov/entrez/q..._uids=11882727

This study showed an increased incidence of perinatal death in women with a history of infertility when infertility treatments were not used to conceive:

http://www.ncbi.nlm.nih.gov/entrez/q...&dopt=Abstract

So there is evidence that the very fact that a couple has fertility problems is a factor, regardless of whether infertility treatments are used or not.

A good editorial to read on this issue is:

N Engl J Med. 2002 Mar 7;346(10):769-70

• Infertility Treatment — More Risks and Challenges
  
  Infertility is defined by the failure to conceive after 12 months of unprotected intercourse, and it affects an estimated 10 percent of the population of reproductive age in the United States.[1] Medical approaches to overcoming infertility include artificial insemination and stimulation of ovulation with medication. More invasive techniques requiring the use of assisted reproductive technology involve the external manipulation of both egg and sperm and include in vitro fertilization and intracytoplasmic sperm injection. When successful, the use of assisted reproductive technology dramatically increases the risk of multiple births[2] and, in so doing, increases the risk of low birth weight (a birth weight of less than 2500 g). It is unclear, however, whether the use of assisted reproductive technology also increases the risk of low birth weight among singleton infants or increases the risk of birth defects.
  
  Two studies in this issue of the Journal[3,4] bear directly on these questions. In one study, Schieve et al.[3] compared the rate of low birth weight among liveborn infants conceived with procedures involving assisted reproductive technology in the United States in 1996 and 1997 with the rate in the general population. A total of 23 percent of 137,000 procedures resulted in live births. In the 57 percent of deliveries that involved multiple births, low birth weight was predictably common, but it was no more common among multiples conceived with assisted reproductive technology than among those in the general population.
  
  The situation was different among singletons. Although there was a slight increase in the risk of low birth weight among preterm singletons, the risk of low birth weight among term singletons conceived with assisted reproductive technology was 2.6 times that in the general population (6.5 percent vs. 2.5 percent). The risk did not vary substantially according to the cause of infertility. Because the risk was elevated among infants who had been carried by apparently healthy women, the authors suggest that the excess rate of low birth weight may be attributable to the use of these forms of technology.
  
  Information on birth defects is not as simply or systematically obtained as data on birth weight. Past studies of birth defects have been limited by potential overreporting or underreporting of defects among infants conceived with assisted reproductive technology and by the lack of similarly screened comparison groups.[5,6,7,8] In a second study in this issue, Hansen et al.[4] combined data from three comprehensive registries in Western Australia: one of procedures involving assisted reproductive technology, one of deliveries, and one of birth defects. By one year of age, one or more major birth defects had been identified in 9.0 percent of babies conceived with assisted reproductive technology, as compared with 4.2 percent of those who were conceived naturally. Rates were similar for in vitro fertilization and intracytoplasmic sperm injection. Excess defects were observed among multiple, singleton, and term singleton births. Increases in risk with the use of assisted reproductive technology were found in most categories of defects, and the differences were significant for musculoskeletal and cardiovascular defects.
  
  Both studies benefited from laws requiring reporting of procedures involving assisted reproductive technology, so problems of incomplete or selective reporting were minimized. Schieve et al. distinguished true singleton pregnancies from those that had originated as multiple gestations and also controlled for other factors, such as age and parity. Hansen et al. used a common scheme for the classification of birth defects in all infants. By having an independent pediatrician identify defects that might have been detected only because of increased surveillance, the authors demonstrated that enhanced detection did not explain the excess rate of defects associated with assisted reproductive technology.
  
  These findings will help infertile couples to evaluate the risks they and their offspring might face if they choose to use assisted reproductive technology. However, an important consideration is the absolute risk of these complications, rather than the relative risk. The use of assisted reproductive technology appears roughly to double the risk of having a term singleton with low birth weight or a child with a major birth defect. However, the majority of couples who require assistance with reproduction will not be affected, since according to these studies, the likelihood of having a term singleton infant of normal birth weight is about 94 percent, and the likelihood of having an infant who is free of major defects is about 91 percent.
  
  Neither these nor previous studies [7,8,9] identify the reason for these excess risks of low birth weight and birth defects. In particular, they do not allow us to distinguish whether these risks are due to the underlying infertility or to the drugs and procedures used to overcome it. To infertile couples who desire pregnancy and require assisted reproductive technology to achieve it, the distinction may be irrelevant.
  
  But what determines the need for assisted reproductive technology? Although there is a standard definition of infertility, other factors (such as a woman's age) influence the decision to use such technology. Unfortunately, studies of assisted reproductive technology rarely describe the eligibility criteria for the use of these procedures. This limitation is complicated by the rapid growth in the use of assisted reproductive technology. A recent news report noted that the number of in vitro fertilization procedures in the United States increased by 37 percent between 1995 and 1998.[10] The growing numbers of fertility specialists and clinics have increased the competition for clients, which has led to aggressive marketing of fertility services to referring doctors and directly to consumers, as well as to reductions in costs, with some clinics offering attractive financing programs.[10]
  
  The studies in this week's issue focus on the outcomes of procedures performed in the mid-1990s. Since neither report provided eligibility criteria for the use of assisted reproductive technology, we must assume that their findings reflect the risks for couples who met the criteria for the use of these procedures during those years. A real concern is that the increased marketing of these services will lead to their use by couples who, in previous years, would have waited longer before seeking help. We can expect that such marketing will attract at least some couples who would have conceived without assisted reproductive technology had they tried to conceive naturally for a few months longer.
  
  Here is where questions of causality become critical. If infertility itself causes the increased risks of low birth weight and birth defects, providing assisted reproductive technology to couples who are not really infertile will involve stress, time, and money, but the costs will not include an excess rate of low birth weight or birth defects. On the other hand, if it is the drugs or procedures involved that lead to these complications, then the use of assisted reproductive technology for couples who are not infertile would result in unfortunate — and avoidable — excess risks of low birth weight and birth defects.
  
  For couples who are currently concerned about fertility, the messages seem clear. For those in whom pregnancy could not otherwise occur, assisted reproductive technology offers great hope, with risks of adverse outcomes that many would consider acceptable. However, the risks demonstrated by Schieve et al. and Hansen et al. may not be acceptable for all couples and must be considered as assisted reproductive technology is increasingly marketed to health care providers and the public.
  
  
  Allen A. Mitchell, M.D.
  Boston University School of Public Health
  Boston, MA 02118
  
  References
  
  1. Frequently asked questions about infertility. Birmingham, Ala.: American Society of Reproductive Medicine, 2000-2001. (Accessed February 13, 2002, at http://www.asrm.org/Patients/faqs.html.)
  2. 1999 Assisted reproductive technology success rates: section 2: ART cycles using fresh, nondonor eggs or embryos. Atlanta: National Center for Chronic Disease Prevention and Health Promotion. (Accessed February 13, 2002, at http://www.cdc.gov/nccdphp/drh/art99/section2.htm.)
  3. Schieve LA, Meikle SF, Ferre C, Peterson HB, Jeng G, Wilcox LS. Low and very low birth weight in infants conceived with use of assisted reproductive technology. N Engl J Med 2002;346:731-737.
  4. Hansen M, Kurinczuk JJ, Bower C, Webb S. The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization. N Engl J Med 2002;346:725-730.
  5. Mitchell AA. Intracytoplasmic sperm injection: offering hope for a term pregnancy and a healthy child? BMJ 1997;315:1245-1246.
  6. Bonduelle M, Legein J, Buysse A, et al. Prospective follow-up study of 423 children born after intracytoplasmic sperm injection. Hum Reprod 1996;11:1558-1564.
  7. Licata D, Garzena E, Mostert M, Farinasso D, Fabris C. Congenital malformations in babies born after assisted conception. Paediatr Perinat Epidemiol 1993;7:222-223.
  8. Kurinczuk JJ, Bower C. Birth defects in infants conceived by intracytoplasmic sperm injection: an alternative interpretation. BMJ 1997;315:1260-1266.
  9. Bergh T, Ericson A, Hillensjo T, Nygren KG, Wennerholm UB. Deliveries and children born after in-vitro fertilisation in Sweden 1982-95: a retrospective cohort study. Lancet 1999;354:1579-1585.
  10. Kolata G. Fertility Inc.: clinics race to lure clients. New York Times. January 1, 2002:F1.

Ivf
 

Now that I have thought about it more, another thing I want to point out is that infertility is defined by the failure to conceive after 12 months of unprotected intercourse.

So it would be really hard to do the study you are suggesting since
if you are not having unprotected intercourse for 12 months with the sperm donor, then you really don't know your fertility status with that sperm donor. At least some of the gay people who are using assisted reproductive techniques because they have no desire to have sexual intercourse with the opposite sex may in fact be infertile. But there is no way to tell that if they aren't willing to have sex with the opposite sex for the requisite period of time. You cannot just assume that they are fertile without actually having them have unprotected sexual intercourse for 12 months.

My only other advice is to move to Illinois, or one of the very few other states that mandate infertility coverage. Damn stuff is expensive!

Ivf
 

From what I've heard, you really don't want to go the IVF route if you don't have fertility problems. You have to give yourself hormone shots and then there is the procedure to harvest your eggs and another to implant embryos. And it is tremendously expensive. If you aren't interested in DIY (I know a woman who actually did the turkey baster thing herself), you could get the artificial insemination done in a clinic.

As for IVF for women having a hard time conceiving, I know 4, all of whom did it because they couldn't get pregnant: one had success with her first try (she is quite small so they only implanted two embryos and she had one baby -- very healthy); one tried several times over a number of years and never conceived; one tried a couple times and then went for international adoption and the most recent one has tried once without success and is discussing with her husband whether to try again.

Ivf
 

Ally -- our friends have twin girls born thru in vitro fertilization. At age four, they are perfectly healthy and well within normal size range.