Severe ocular abnormalities found in children born after in vitro fertilization

Ocular malformations and a high rate of refractive error may be due to IVF-induced chromosomal aberrations, a study shows.

ByMichela Cimberle

JERUSALEM – Children born after in vitro fertilization seem to have a higher chance of being affected by severe ocular anomalies, according to a study recently published in Archives of Ophthalmology.

“In our pediatric ophthalmology unit we examined 47 children, aged between 2 months and 7 years, born after IVF-induced pregnancies. We found a surprisingly high rate of refractive error and major structural malformations that were not justified by family inheritance. In most cases they were uniocular, and there was no positive family history of the pathologic conditions affecting the children,” said co-author Irene Anteby, MD, of the Hadassah University Hospital here.

Visual acuity and refraction

All 47 children underwent a thorough ophthalmologic examination. At the time of examination, 12 children were verbal and 35 children were not. Of 70 eyes of nonverbal children, 60 had vision normal for age, four had “questionably normal” vision and 6 had poor, “definitely abnormal” vision. In the 12 verbal children visual acuity was 20/32 or better in 17 eyes, 20/40 to 20/100 in two eyes, 20/120 to 20/300 in one eye, 20/400 to light perception in one eye and no light perception in two eyes.

“In 10 eyes, refraction could not be measured due to intraocular pathologic conditions, and two eyes were aphakic at the time of our examination as they had undergone cataract surgery without IOL implantation. Of the remaining 82 eyes, only 22 were emmetropic, while 47 had hyperopia of more than +1 D and 13 eyes had a myopic refraction of –0.5 D or more. In 20 eyes the refractive error was more than ± 3.0 D,” Dr. Anteby said.

Severe malformation

Retinopathy of prematurity was observed in two cases, but was justified, as in the non-IVF population, by the early gestational age of the infants.

“Serious consideration, however, should be given to the fact that 12 of the 47 children presented major ocular malformations, such as glaucoma, cataract, retinoblastoma, Coats disease, retinal and optic nerve coloboma, hypoplastic optic nerves and optic atrophy,” Dr. Anteby said.

“Since there was no family history of such conditions in the infants’ families, one assumption may be that in vitro fertilization is responsible for chromosomal aberrations occurring during embryogenesis and resulting in structural abnormalities of the eyes and, possibly, of other organs. Our findings confirm what has already been said by some other studies on the incidence of chromosomal aberrations in infants born after IVF,” she said.

Early detection is mandatory

It can be inferred that other organs are likely to be affected in the same manner. Dr. Anteby pointed out that structural anomalies are easily detectable in the eye, where they produce manifest alterations of visual functions, while in other organs they may be present, but remain asymptomatic and therefore undetected for a long time.

“The results of our study, although limited and nonrandomized, should stimulate us to do further investigation and be more aware of ocular (and possibly not only ocular) malformations in children born after IVF,” she said.

She pointed out that ophthalmologists and — even more — obstetricians and gynecologists should be alerted when dealing with IVF newborn children and pregnancies, as an early diagnosis and even prenatal detection of these abnormalities may be critical for the possibility and efficacy of treatment.

“Ultrasonography can detect some of the major ocular malformations in utero, but the eyes are not always given a thorough examination. A special attention to the visual apparatus during periodic ultrasound scanning in IVF mothers could save the sight of many of these children.”

For Your Information:

Irene Anteby, MD, can be reached at the Pediatric Ophthalmology Unit, Department of Ophthalmology, Hadassah University Hospital, Jerusalem, Israel; +(972) 2-677-8707 or +(972) 2-677-6397; fax: +(972) 2-677-8297; e-mail: irene@hadassah.org.il.

Reference:

Anteby I, Cohen E, et al. Ocular manifestations in children born after in vitro fertilization. Arch Ophthalmol. 2001;119:1525-1529.