Original Research
Obstetrics
Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years

Presented at the Society of Maternal and Fetal Medicine Annual Pregnancy Meeting, Las Vegas, NV, January 23–28, 2017.
https://doi.org/10.1016/j.ajog.2017.01.015Get rights and content

Objective

Studies have questioned the long-term health effects of offspring conceived after fertility treatments.

Methods

We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years.

Study Design

A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991–2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors.

Results

During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms(0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P<.001). The association between in vitro fertilization and total pediatric neoplasms and the association between any fertility treatments and malignancies remained significant; we controlled for confounders such as gestational diabetes mellitus, hypertensive disorders, preterm birth, and maternal age (adjusted hazard ratio, 2.48; 95% confidence interval, 1.71–3.50; and adjusted hazard ratio, 1.96; 95% confidence interval, 1.14–3.36, for all neoplasms and all malignancies, respectively).

Conclusion

Children conceived after fertility treatments are at an increased risk for pediatric neoplasms.

Section snippets

Methods

A population-based cohort analysis was performed that included all singleton infants born during the years 1991–2013 and discharged alive from Soroka University Medical Center (SUMC). SUMC includes the largest birth center in Israel and is the only tertiary hospital in Israel’s southern region and the single IVF unit in the region. In Israel all fertility interventions, which includes IVF, are covered fully by a national health law (1997), which allows citizens of all backgrounds access to

Results

During the study period, 242 187 newborn infants met the inclusion criteria: 2603 of whom (1.1%) were conceived after IVF; 1172 of whom (0.7%) were conceived after OI, and 237,863 of whom (98.3%) were with pregnancies that were conceived spontaneously. The rates of IVF have changed from 0.2% of the offspring in 1991 to 1.8–2.0% in the years 2012–2013; OI rates were 1.0% (1991) and 0.5% (2013). Table 1 presents background information of the study population, which includes demographic,

Comment

In this large population-based study with a long follow-up period, children who were conceived via fertility treatments, specifically those who were conceived via IVF, were found to be at an increased risk for future pediatric neoplasms compared with spontaneously conceived children. Moreover, this association was found to be independent of several important perinatal characteristics such as gestational age and birthweight. The low rates of fertility treatments and IVF specifically can be

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    The authors report no conflict of interest.

    Cite this article as: Wainstock T, Walfisch A, Shoham-Vardi I, et al. Fertility treatments and pediatric neoplasms of the offspring: results of a population-based cohort with a median follow-up of 10 years. Am J Obstet Gynecol 2017;216:314.e1-14.

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