FERTILITY treatment can triple the chances of a child being born with cerebral palsy, says a study released today.

Doctors in Sweden compared the incidence rate of neurological problems in 5,680 children born after in vitro fertilisation (IVF) treatment, and 11,360 children conceived naturally.

They found that IVF children were about three times more likely to have cerebral palsy, a disorder which causes spasticity. 

Suspected slow development was four times more common in children whose conception was assisted. However, twins conceived naturally bear a similar risk to that of twins born after IVF, indicating a link with multiple pregnancies.

Dr Bo Stromberg, from Uppsala University Children's Hospital, said: "Our study suggests that children born after IVF have an increased risk of neurological problems, especially cerebral palsy.

"These risks are largely due to the high frequency of twin pregnancies, low birthweight, and prematurity among babies born after IVF. To limit these risks, we recommend that only one embryo should be transferred during IVF."

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Family Fact of the Week: A Dutch Study 

"Researchers in the Netherlands have found indications of an increased risk of up to seven times of eye cancer among children conceived by IVF.

...Retinoblastoma, a malignant tumour in the retina, occurs in only about one in 17,000 births in western countries.

However Dutch investigators led by Dr Annette Moll, from VU University Medical Centre in Amsterdam, diagnosed the disease in five IVF children born within 15 months of each other. This prompted the team to compare these cases with the expected incidence of retinoblastoma in the normal population. The researchers estimated that children conceived by IVF could be between five and seven times more likely than non-IVF children to develop retinoblastoma.

Between 1 per cent and 1.5 per cent of Dutch babies are born with the help of IVF, which is used to treat 3,000 women each year."
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Family Quote of the Week: An English Study

"Scientists called for an investigation into the safety of artificial fertility techniques last night, after a study showed that test-tube babies were more likely to be born with a rare genetic disorder than children conceived naturally.

A team of British researchers found that in vitro fertilisation (IVF) babies were at greater than average risk of Beckwith-Wiedemann syndrome - a condition that can cause birth defects and childhood cancer. Although the risks are small, the findings raise concerns about a technique used to create 68,000 children since 1978."

(Source: David Derbyshire, "IVF safety fears over link to birth defects," The Daily Telegraph (London), 16 January 2003.)  

Family Research Abstract of the Week: A Swedish Study: More Test Tube Troubles

"Almost 50,000 children are now born worldwide every year after IVF [in vitro fertilization], yet the effects of IVF on long-term health of infants are unknown," state the authors of a Swedish study of the neurological effects of in vitro fertilization published in The Lancet.

Noting some of the known short-term negative consequences of IVF, the researchers continue: "Numerous studies have dealt with the short-term outcome of IVF--i.e., number of pregnancies achieved, multiple pregnancies, infants born, infant mortality, and different malformations. Thus, rates of prematurity, low birthweight, and the children's need for neonatal intensive care have been reported. However, studies on the long-term outcome, with focus on neurological sequelae of children born after IVF are rare."

As a result, medical professionals in Sweden set forth to conduct a study including the cooperation of the Swedish Paediatric Association, the Swedish Society for Obstetrics and Gynaecology, and the National Board of Health and Welfare, ultimately collecting data on all children born between 1982, when the first Swedish child born as a result of IVF was delivered, and December 31, 1995: "4353 women had 5680 infants (3228 singletons, 2060 twins, 367 triplets, and 25 quadruplets) after IVF between 1982 and Dec 31, 1995." Today, children conceived via IVF constitute 2 percent of all infants born in Sweden.

The Swedish researchers found that, in general, children born as a result of in vitro fertilization were almost twice more likely to need neurological therapy than naturally conceived children (odds ratio 1.7, 95% CI 1.3-2.2).

In particular, the most common neurological diagnosis was cerebral palsy, for which, children conceived using IVF were 3.7 times more likely than naturally conceived children to have cerebral palsy, (95% CI 2.0-6.6). Even for singletons, children born subsequent to IVF were almost three times more likely to be diagnosed with cerebral palsy (odds ratio 2.8, 95% CI 1.3-5.8). The researchers add: "Although low birthweight, low gestational age, and male sex were strong risk factors, IVF independently contributed to risk of development of cerebral palsy."

The risk for suspected developmental delay, the second most common neurological diagnosis, "was increased four-fold (1.9-8.3) in children born after IVF," compared to naturally conceived controls. Furthermore, "When singletons were studied separately, this risk was reduced, but it was still double that seen in controls," (odds ratio 2.0, 95% CI 0.7-5.4).

While the authors point out that, "[w]ith respect to congenital malformations, mental retardation, chromosomal aberrations, and behavioural disorders, we saw no differences between children born after IVF and those born after a natural conception," the prevalence and seriousness of the neurological problems that are linked to IVF-cerebral palsy and developmental delay, among others-cast a dark pall over the continuing practice of in vitro fertilization.

Source: B. Strömberg, G. Dahlquist, A. Ericson, O Finnström, M. Köster, and K. Stjernqvist, "Neurological Sequelae in Children Born after In Vitro Fertilisation: A Population-Based Study," The Lancet, vol. 359, no. 9305 [February 2002], 461-465.
 
 

A MOTHER who gave birth to quadruplets after fertility treatment went wrong won more than £1 million in damages yesterday for their "wrongful conception and wrongful birth".

Vivien Heath, 37, and her husband Clive, 42, will receive the payout from their local health authority for allowing her to conceive the children and then failing to reduce her pregnancy from four babies to two.

One of the babies died and the remaining three suffered varying forms of disability after they were born three months prematurely on Christmas Eve 1992. 

The three surviving children, boys Kristian and Matthew, and a girl, Ellis, now aged eight, will also receive damages. 

Nathan developed severe breathing problems at birth and died 34 hours later. Kristian had a massive brain haemorrhage, suffers from cerebral palsy, visual problems and delayed physical development.

Matthew suffered a partially-collapsed lung and has learning difficulties. Ellis, who weighed 1lb 15oz at birth, suffered chronic lung disease.

Mr Justice Leveson, sitting at the High Court, approved settlement of all the claims, with the amount to be assessed. The final total is expected to exceed £1 million. 

Adrian Whitfield, QC, for the family, told the judge that, in early 1992, the couple, from Orpington, Kent, opted for fertility treatment after having problems conceiving a sibling for their son Ryan, now 14.

Mrs Heath attended Farnborough Hospital in Kent and was prescribed the fertility drug Clomid. When that did not work she was given a more powerful drug, Metrodin, to stimulate her ovaries to produce eggs, and another drug, Pro-fasi, to trigger ovulation.

Mr Whitfield said that there was a risk of over-stimulation and over-production in the release of eggs, which obstetricians should have ensured did not happen. 

However, Mrs Heath was not given an ultrasound or offered treatment to reduce the number of eggs. 

Mr Whitfield said: "Mrs Heath said she should have been warned in clear terms of the hazards presented by a quadruple pregnancy and offered a referral to specialists, who would have offered a reduction of some if not all of the foetuses." 

He added: "They could have been reduced to twins, which would have been born later and born healthy."

Bromley Health Authority, responsible for the hospital, admitted liability for its breach of duty of care to the couple and agreed to the settlement of the children's claims without admitting liability.

Mr and Mrs Heath, who have since given birth to another son, Max, who was conceived naturally, declined to comment after the hearing.

Half fertility treatment women have multi births 
By Celia Hall, Medical Editor 
(Filed: 13/12/2000) 
 

MULTIPLE births which put mothers and babies at greater risk make up nearly half of all births through in vitro fertilisation and other high technology fertility techniques.

The Human Fertilisation and Embryology Authority (HFEA) said yesterday that early next year it would be discussing the practice of transferring up to three embryos at one time, with a view to modifying current guidelines.

The HFEA annual report for 2000 and analysis of the year 1998/9 showed that the incidence of multiple birth "and attendant risk to maternal and infant health" as a result of IVF and micromanipulation of sperm and eggs, remained high and had been almost unchanged since 1994.

In the year reviewed, 47 per cent of individual babies born from all types of IVF came from multiple pregnancies, 3,873 out of 8,337 births. Of these, 3,254 were twins, 613 were triplets and six were quads. The report said: "The stillbirth and neonatal death rate for a triplet pregnancy with one or more babies dying is 59.6 per 1,000 birth events compared with 9.9 per 1,000 for single pregnancies."

The HFEA allows three embryos to be transferred but "encourages" clinics to transfer two to avoid the risk of multiple pregnancies. The report said: "Encouragingly the number of embryo transfers where the maximum of three embryos were replaced has fallen steadily from 68.6 per cent in 1995/96 to 50.5 per cent in 1998/99. But there were still more three embryo transfers in the year, 7,073 compared with two embryo transfers, 6,833.

More than 50,000 babies had now been born in Britain using IVF treatment since 1978, half of them born in the past three years. Success rates continued to rise. In 1998/99 the live birth rate overall was 18.2 per cent compared with 16.4 per cent in the previous year. In younger women aged 29 to 32 the live birth rate average for all clinics was up to 25 per cent.

The HFEA also publishes today its clinic guides which show wide differences between units. For example the Assisted Reproduction and Gynaecology Centre, London, has a live birth rate of 43.4 per cent in women treated under the age of 38 while the Homerton Hospital, Hackney doing half the number of comparable fertility treatments, has a live birth rate of 4.4. It attempted only seven IVF treatments compared with 95 at the ARGC.

Ruth Deech, chairman of the HFEA, said well-established clinics with wide experience tended to have better live birth rates.