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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guest post: the reality of breastfeeding?

A few days ago, I stumbled across some articles about breastfeeding. They weren’t the usual uber-positive articles I was used to encountering. The first article purported to be a no-holds-barred account of the difficulties one can encounter when breastfeeding.  The second article, while a few months older, was more extreme about the pain a mother can encounter while breastfeeding.

OK. True confession time. I didn’t breastfeed my son. Hell, I didn’t even carry him. He came to us via gestational surrogacy, and I decided not to attempt to induce lactation. Our awesome gestational carrier did pump breast milk for him for almost 6 months.

It may seem like I don’t have a dog in this fight, but I do because I’m a woman and a mother.  The prevailing message about breastfeeding is that it is best and if you don’t do it, you’re denying your baby his/her natural food. It’s also irreplaceable bonding time. Not breastfeeding might damage maternal-child attachment.  Not breastfeeding might doom your child to a variety of poor outcomes. Not breastfeeding may even doom you, the mother, to serious breast or ovarian cancer.

I’ve watched what the pressure to breastfeed has instigated. I’ve had too many friends both offline and online berate themselves if breastfeeding doesn’t work out or even when they decide to stop pumping.  Wondering what is wrong with them if their breastfeeding journey is more of a struggle than they thought it would be. They feel as if they’ve failed their child and failed as a woman. At the very least, they feel disappointed in themselves and their experience with breastfeeding. Add in infertility, and a failure to breastfeed or less time breastfeeding than one wishes becomes yet another way in which our body has betrayed us.

And I don’t want any woman to feel that way about herself and her body ever. Ever. I’m not trying to start a debate about breastfeeding. Truly. But I am adamant about the power of mommy blogging. I credit mothers blogging with helping to pull back the curtain on motherhood and demonstrate the reality of what motherhood is like. It has major highs and lows, and mothers are not one-dimensional characters. It can be both awesome and suck at the same time.  These are messages society has not been used to seeing, but they are necessary.

I’d like to see the same attention given to how we feed our babies. How you fed your baby is part of the lingua franca of motherhood, meaning that you can’t join a mommy’s group or meet a group of mothers without method of sustenance becoming practically an ice breaker. And source of judgment.

I’m not against breastfeeding. Far from it.  What I appreciate about these articles is that they bring scrutiny and awareness to the reality of breastfeeding. For some women, it is hard. For some women, it doesn’t work. It isn’t a bed of roses for every woman, and while breastfeeding is laudable, it should not be held up as the only acceptable way and only positive, easy stories portrayed. If your nipples are falling off, for God’s sake, find a different way to feed your baby!

I support every woman and whatever choices she makes, but I don’t want any woman to feel compelled to pursue a certain direction because of peer pressure and one-sided media representations.

What do you think? Do you think articles like these provoke fear or do you think they are a needed reality check?

What kinds of articles about feeding your baby would you like to see the media and blogs tackle?

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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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