The research published in JAMA Network Open on the association between infertility and the risk of Autism Spectrum Disorder (ASD) in children provides critical insights into the potential impacts of different modes of conception on child neurodevelopment. This study, conducted in Ontario, Canada, included a substantial cohort of over 1.3 million children and categorized them based on their mode of conception: unassisted, subfertility (infertility without treatment), and assisted reproductive techniques like ovulation induction, intrauterine insemination, in vitro fertilization, or intracytoplasmic sperm injection.

The study found that children born to individuals with infertility had a slightly increased risk of ASD, with the incidence rate of ASD being 1.93 per 1000 person-years in the unassisted conception group. Compared to this group, the adjusted hazard ratios for ASD were 1.20 in the subfertility group, 1.21 following ovulation induction or intrauterine insemination, and 1.16 after in vitro fertilization or intracytoplasmic sperm injection. Notably, obstetrical and neonatal factors appeared to mediate a significant portion of the association between mode of conception and ASD risk. For example, following in vitro fertilization or intracytoplasmic sperm injection, factors like cesarean birth, multifetal pregnancy, preterm birth, and severe neonatal morbidity played a substantial role in mediating the risk of ASD​​​​.

Further insight into the relationship between assisted reproductive technology (ART) and ASD comes from a CDC report examining children born in California between 1997 and 2007. This report found that children conceived using ART were about two times more likely to be diagnosed with ASD compared to children conceived without using ART. The increased risk for ASD in pregnancies conceived with ART was largely due to the higher likelihood of adverse pregnancy and delivery outcomes, like being born as a twin or multiple, being born too early, or being born too small. Additionally, the type of ART procedure impacted the ASD risk, with a higher likelihood of ASD diagnosis in children conceived using intracytoplasmic sperm injection compared to conventional in vitro fertilization. These findings suggest that single embryo transfer, where appropriate, may reduce the risk of ASD among children conceived using ART​​.

Moreover, the CDC report also highlighted that children conceived using ART had a lower median age of autism diagnosis compared to those not conceived with ART. However, despite earlier identification, these children were less likely to have co-occurring intellectual disability or severe deficits in communication and social functioning. The differences in autism diagnosis age and symptom severity were largely accounted for by socio-demographic differences between ART-conceived and non-ART-conceived children. This suggests that earlier identification of autism in children from more advantaged families, who typically have greater access to ART services, contributes to the observed ART-autism association​​.

Overall, these studies underscore the complexity of the relationship between infertility treatments and the risk of ASD in children. They highlight the need for focused care and pregnancy plans for individuals with infertility, both with and without fertility treatment, and emphasize the importance of considering a range of obstetrical and neonatal factors to optimize child neurodevelopment.

Sources: 

JAMA Network Open
Infertility and Risk of Autism Spectrum Disorder in Children

Medical Xpress
Risk for autism increased for children born to those with infertility

Center for Disease Control and Prevention
Key Findings: The association between assisted reproductive technology and autism spectrum disorder