Hum. Reprod. Advance Access published online on September 12, 2009
Human Reproduction, doi:10.1093/humrep/dep310
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The Groningen ART cohort study: ovarian hyperstimulation and the in vitro procedure do not affect neurological outcome in infancy
1 Department of Paediatrics, Division of Developmental Neurology—CA85, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands 2 Department of Obstetrics and Gynaecology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands 3 Department of Paediatrics, Division of Neonatology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands 4 Department of Epidemiology, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
6 Correspondence address. Tel: +31 50 3614250; Fax: +31 50 361 9158; E-mail: k.j.middelburg{at}developmentalneurology.com
BACKGROUND: Due to the growing number of children born following assisted reproduction technology, even subtle changes in the children's health and development are of importance to society at large. The aim of the present study was to evaluate the specific effects of ovarian hyperstimulation and the in vitro procedure on neurological outcome in 4–18-month-old children.
METHODS: In this prospective assessor-blinded cohort study, we included singletons born following controlled ovarian hyperstimulation in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) (COH-IVF; n = 68) or modified natural cycle-IVF/ICSI (MNC-IVF; n = 57) or naturally conceived singletons of subfertile couples (NC; n = 90). Children were assessed with standardized, age-specific and sensitive neurological assessments (TINE and Hempel assessment) at 4, 10 and 18 months. Neurological examination resulted in a neurological optimality score (NOS), a fluency score and a clinical neurological classification. Fluency of movements is easily affected by neurological dysfunction and is therefore a sensitive measure for minimal changes in neuromotor development.
RESULTS: The NOS and the fluency score were similar in COH-IVF, MNC-IVF and NC children. None of the children showed major neurological dysfunction and rates of minor neurological dysfunction at the three ages were not different between the three conception groups.
CONCLUSIONS: We found no effects of ovarian hyperstimulation or the in vitro procedure itself on neurological outcome in children aged 4–18 months. The findings of our study are reassuring, nevertheless it should be kept in mind that subtle neurodevelopmental disorders may emerge when children grow older. Continuation of follow-up in older and larger groups of children is therefore still needed.
Key words: assisted reproductive technology/IVF/child/follow-up/neurodevelopmental outcome
5 Present address: Department of Obstetrics and Gynaecology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
Submitted on April 23, 2009; resubmitted on July 13, 2009; accepted on July 16, 2009.