Adolescents conceived via assisted reproduction do not have worse mental health

Adolescents who were conceived via assisted reproductive techniques were not at increased risk for poor psychiatric health compared with the general population, according to study results published in JAMA Psychiatry.

“Because some researchers argue that emotional stress can contribute to infertility, depression and anxiety could be more common among children born to couples with infertility, with [assisted reproductive technique (ART)] use further facilitating the transmission of such traits to the next generation,” Chen Wang, MPH, of the department of medical epidemiology and biostatistics at Karolinska Institutet in Sweden, and colleagues wrote. “However, the psychiatric health of children and adolescents conceived by ARTs has not been studied extensively, and previous studies relied on self-reports, as well as inappropriate model adjustments, including mediators such as preterm birth.”

The investigators aimed to address this research gap by prospectively following a nationwide birth cohort. They linked Swedish population registers with coverage through 2018 and included all children (n = 1,221,812; 48.6% girls) born in Sweden between January 1994 and December 2006. They completed follow-up on Dec. 31, 2018, when participants were aged 12 to 25 years. As the exposures, Wang and colleagues used in vitro fertilization with or without intracytoplasmic sperm injection and transfer of fresh or frozen-thawed embryos. Clinical diagnoses of mood disorder, including major depression, anxiety, obsessive-compulsive disorder or suicidal behavior, identified via hospital record and outpatient specialist care, served as the main outcomes and measures. They also identified suicide via death certificates and antidepressant use via dispensations of prescribed medications.

A total of 31,565 (2.6%) participants were conceived via ART. Results showed these participants had an increased risk for OCD (HR = 1.35; 95% CI, 1.2-1.51) compared with all others. However, adjustment for parental characteristics (adjusted HR = 1.1; 95% CI, 0.98-1.24) attenuated the association and made it no longer statistically significant. When restricting the analysis to individuals born to couples with known infertility (aHR = 1.02; 95% CI, 0.89-1.17), the association was no longer present. The researchers observed no increased risk for depression or suicidal behavior among adolescents conceived via ARTs compared with other adolescents, regardless of parental infertility. Fertilization type did not appear to affect outcomes. Fresh, but not frozen, embryo transfer correlated with decreased risk for mood disorders (aHR = 0.9; 95% CI, 0.83-0.97) compared with children of couples with infertility who were not conceived via ART. The researchers noted this made frozen embryo transfer seem less advantageous upon direct comparison with fresh embryo transfer.

“The findings were reassuring with respect to the psychiatric health of adolescents conceived with ARTs,” Wang and colleagues wrote. “An elevated risk of OCD in the overall comparison with all other adolescents may be explained by differences in parental characteristics, and parental use of ARTs could be a candidate in potential screening of this disorder.”