news item: Latest IVF Scare: ICSI and Intellectual Disabilities

The news was full of dramatic headlines about the results of the latest IVF study last week. This study, the first to compare IVF treatments and the risk of neurodevelopmental disorders in children, found that ICSI was associated with an increased risk of intellectual disability and autism in children.

Researchers analyzed over 2.5 million Swedish birth records and compared those born via IVF with those conceived naturally. Here’s the data:

  • 1.2% or 30,959 children were born via IVF
  • Of the 6959 children diagnosed with autism, 103 were born via IVF
  • Of the 15,830 with intellectual disability, 180 were born via IVF

The Good News

While there does not appear to be an increased risk for autism for children born from IVF, there is a small increased risk of intellectual disability for children born from IVF: about 47 in 100,000 infants born from IVF compared to 40 in 100,000 for those conceived naturally. Unsurprisingly, this increase disappeared when researchers factored in multiple births.

The Bad News

More concerning, however, was what the researchers found when they compared outcomes by IVF procedures: fresh embryos, frozen embryos, ICSI, and if ICSI was used, how the sperm was obtained (surgically or ejaculated).  The researchers found that children born from IVF utilizing ICSI (regardless of fresh or frozen embryos) were at a 51% increased risk of intellectual disability (62 to 93 births out of 100,000). Even when the researchers adjusted for pre-term and multiple births, IVF using ICSI and fresh embryos was still associated with an increased risk of intellectual disability.

The news outlets are interpreting these findings as a much-needed reminder that male-factor infertility exists and could have ramifications for couples to consider since ICSI began as a treatment for male infertility.  What many of the articles ignore is that clinical usage of ICSI has expanded beyond male-factor infertility to be used for many patients undergoing IVF. My husband does not have male-factor infertility, but our eggs were fertilized using ICSI during both of our fresh IVF cycles because, as this article notes, ICSI works.

The problem is that injecting the sperm into the egg bypasses the “survival of the fittest” process most sperm have to go through to fertilize an egg. I’m speculating here, but it’s likely that the line of though most embryologists and clinics take is that if the sperm is bad, the egg won’t develop or the embryo will arrest before transfer or freezing or will result in an early miscarriage. Nature’s safeguards will still prevail.

I’m concerned that this study and the emphasis it places on male-factor infertility will confirm the general public’s tendency to believe that ART is playing God and that interventions such as IVF and ICSI allow couples who possibly should not be able to reproduce to do so.  I also worry about the despair it could cause couples suffering from male-factor infertility and/or relying on ICSI as part of their treatment arsenal: they really are genetically inferior.

It’s important to remember that the outcome of intellectual disability after ICSI is still very rare and that ICSI remains a safe option for the overwhelming majority of couples using it.  These types of articles frustrate me because they tend to overstate the results of these studies almost gleefully: of course IVF is unsafe. We told you so!  The bottom line is that having children, having healthy children, is a crap shoot that every couple faces regardless of whether they use ART or conceive naturally. And reproductive science continues to advance all the time. On the heels of the sensational IVF/intellectual disability headlines came the news about Connor Levy, a baby born after his parents had cells from their IVF embryos sent to Oxford for scientists to analyze for genetic abnormalities. The results of the analysis enabled the Levys’ doctors to transfer the best embryo; the screening process is being hailed as revolutionizing IVF and potentially reducing the number of multiple births.  Maybe in a few years, we’ll regard the study’s findings about ICSI as a quaint example of IVF’s earlier days.

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What do you think of the results of the survey? Did you use ICSI? Would it change your usage of ICSI?

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Keanne of Family Building With a Twist in her own words: I’m KeAnne (like LeeAnne w/ a “K”). Mommy to 1. Wife to someone who knows how my mind works. Scary (you should see what goes on in my mind). Owned by 3 cats. I work full time and don’t craft or DIY (you’re welcome). I like books, conspiracy theories, Downton Abbey and cooking. I dislike chocolate, zinfandel, carpet beetles and experts. Expect over-thinking, the occasional rant, strong opinions and the occasional (OK, often) piece of useless knowledge.

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Comments

  1. I always get so scared when I read this stuff. Molly was icsiand we only went icsi because of 5 failed transfers even though sperm wasn’t the problem. It worried me because I felt like we were messing with things even more than normal. I was worried during birth and very relieved when she came out “normal”. I must admit I am so relieved every time she meets a developmental milestone on time or in front of because she is ivf and not naturally conceived. Next time though if we don’t have to I will just do straight IVF for two reasons a) I’d like to go with strength of the fittest and b) some half assed notion that would give us a greater chance of a boy!

  2. I didn’t read the article, but was around for the conversation it spurred on FB and twitter. All of my embryos were ICSI’d and it does frighten me a bit about these risks. My daughter has shown some delays, especially in speech. There has also been research about father’s age and the incidence of autism and this combined with intellectual disability risks really worries me. However, because both my husband and I are old, we’re at risk for all sorts of issues regardless of ICSI….it was a crap shoot no matter how we conceived.

    • It really is a crap shoot. I should have put this in the post, but my son sees a speech pathologist, mainly for pragmatics. I could beat myself up over ICSI or shrug and conclude that our son was always destined to be more of a square peg; heavens knows his father and I were/are!

  3. We had to icsi for pgd reasons: there was some concern that multiple sperm attempting to fertilize the egg would contaminate the genetic testing. Whatever the risks are, they outweighed the risks of NOT doing icsi – having a child with cystic fibrosis (or no child at all). It is HARD to make these decisions, but the truth is that they are better thsn the alternative. I have no regrets.

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