Picture Emerging on Genetic Risks of IVF

In November, the Centers for Disease Control and Prevention published a paper reporting that babies conceived with IVF, or with a technique in which sperm are injected directly into eggs, have a slightly increased risk of several birth defects, including a hole between the two chambers of the heart, a cleft lip or palate, an improperly developed esophagus and a malformed rectum. The study involved 9,584 babies with birth defects and 4,792 babies without. Among the mothers of babies without birth defects, 1.1 percent had used IVF or related methods, compared with 2.4 percent of mothers of babies with birth defects.

The findings are considered preliminary, and researchers say they believe IVF does not carry excessive risks. There is a 3 percent chance that any given baby will have a birth defect.

NYTimes

I thought this article was interesting, particularly when contrasted with the recent news about the first baby selected not to have the breast cancer gene.

We put so much faith into science, and so much weight onto the illusion that we can control things. But the more we learn, the more it seems like there are just too many factors to weigh them all. How does a very slight increase in the likelihood that your child with be born with a devastating birth defect compare to the moderate chance that your baby will have breast cancer when he/she is 50?

I think I'd opt for doing it the old-fashioned way, myself.

if it does not work naturally, maybe there's a reason why it doesn't. maybe people whould look for causes instead of bandaids, but i'm probably from the stone age.

that's the reason why i (not so) secretly don't care as much about these Frankenstein ambitions very much as long as they're limited to the human species. i mean they're apparently unlikely to survive on the long run, so why bother, never interrupt while your enemy is making mistakes, right?

just have to do a reasonable but ineffective protest not to arouse suspicion, though...

btw, i'll step out on a limb and predict that these issues will accumulate with each generation that's IVF, first to the point of infertility, then to the point of unviability. just a hunch, though.

We need to consider though that IVF often leads to multiple births which in turn are typically born earlier. These defects could be due to preterm birth as much as they are to the IVF specifically.

reply to post by asmeone2


Well, it does say the findings are preliminary. But if you read the article, many of the conditions they're looking at have to do with changes in gene expression, not prematurity. And it also mentions low birth weight for the gestational age.

And it's not just humans:

If mouse embryos are even close to reflecting what can happen with humans, then there is no question that gene expression can be altered by growing embryos in a laboratory, Dr. Schultz says.

He and several others spent years asking whether there were gene expression changes in mouse embryos that are grown in the laboratory — there are — and whether they could see behavioral changes in the animals. They did.

For example, the investigators gave mice a test that required remembering the location of a platform hidden by opaque water. The IVF mice had no trouble learning where the platform was, but were more likely to forget what they had learned, Dr. Schultz found.

NYTimes

I'm definitely not saying anyone should panic about this news. And I doubt that it will change the minds of people who want children badly enough to go through the expense and difficulty of the procedure. But it's an important piece of the genetic/epigenetic puzzle, it has serious implications not just for fertility research but for gene therapy, and it always seems to me like people are scared to say anything negative about IVF because it comes as such a blessing to couples who can't have children.

Originally posted by asmeone2
We need to consider though that IVF often leads to multiple births which in turn are typically born earlier. These defects could be due to preterm birth as much as they are to the IVF specifically.

Very much so. I actually have known a couple of people with septal wall defects, both were premature (single births, but it's more common for multiples). Neither was the result of an IVF pregnancy, either.

As defects go, there are forms of this that are genetic (usually seen as part of an overall syndrome) but more frequently, it's just a developmental glitch. Interestingly, I have seen some studies that suggested a potential link to oral contraceptive use in the mother, prior to conception, and septal/oral defects.

I don't know if this would also hold true for mothers who are using hormones of a different sort along with IVF treatments, but that's something that might need further research, imho.

Americandingbat and Quiteboard:

I'm not at all saying that some of this isn't due to IVF, but that it can also come from early birth.

It is an important distinction to be made, since early birth can be prevented, but the conditions leaving to IVF use often can't be.

Originally posted by quitebored
I don't know if this would also hold true for mothers who are using hormones of a different sort along with IVF treatments, but that's something that might need further research, imho.

That's a really good point. The other thing I thought of is that women who have IVF tend to be older than average mothers, and it's been known for a long time that the risk of birth defects increases with the mother's age.

Still, it seems important to try to find out more about what's happening. And I was a bit surprised to find that there's no set medium for growing the embryos – which makes trying to determine whether there's a problem in the growth medium really hard.

reply to post by americandingbat


Fraternal multiple births also tend to increase with age, which further complicates this issue.

I support IVF in cases where the parents/mother have 0 or 1 other child and are unable to produce more. They must have gone through fertility clinics, all the tests to rule out genetic problems, seen urologists, the whole bit. Then, if there really is no other option and adoption is out of the question for a good reason (as opposed to "I don't want to.") it's alright to try IVF.

It is NOT okay to use IVF for the production of your seventh child, or if you have a medical condition that could put the health of the baby at risk, or if you haven't even seen a fertility specialist. Because people who think that is okay and are trying it that way are basically allowing scientists to run tests with their embryos and try weird things and now we end up with tons of babies that could probably have been created using a more natural method.

Originally posted by asmeone2
reply to post by americandingbat

 

Fraternal multiple births also tend to increase with age, which further complicates this issue.

Interesting additional point--both the people I've known with those defects were to older moms (one was 35, the other was 30-something; in both cases, they were the "babies" of their families, so born much later), so yes, age is a point to consider, too.

There are probably a lot of factors that tie in to problems with IVF procedures:

* Typically, women who get IVF treatments are older; even with natural pregnancies, the older the woman is, the greater the chance of birth defects or problems with the baby

* Fertility drugs; is most cases of IVF, the woman is on fertility medications in order to ready her body for implantation

* The chance for multiple "takes"; generally, more than one fertilized egg is implanted and that leads to the chance of multiple takes which leads to a multiple pregnancy.....the more babies, the greater the chance for premature birth (low birth weight, not fully developed organs and systems, etc.)

And, another thing I've thought of.....could these higher risks of problems with the fetus and later on the child have something to do with the "trauma" that the egg and sperm receive during the retrieval and fertilization processes?

I mean sperm is ejected from the body into a cup and then frozen before being sucked into an implement. The eggs are sucked out of the body and then pierced with a sharp implement to inject the sperm. Could those processes somehow "damage" the egg and/or sperm hence leading to some of the more similar problems found with IVF babies? Because it seems to be a small, similar group of problem.....not all of the problems that can occur with the natural process.

Just a thought I had...

Skeptic--

I do not know that it is scientifically provable, but just the fact that mom/dad cannot conceive should indicate some kind of genetic damage, right? Perhaps it is the damage in their cells, not the IVF on its own, that causes the birth defects in these cases?

reply to post by asmeone2


It could be, but the egg and sperm go through trauma to get to the point of IVF and implantation. Since this is a small group of defects that were found instead of the whole gamut that occurs in nature, it could be that the trauma plays a factor.

That's just a thought that comes to my mind after thinking about it for a bit.

It could very well be genetics, but that would require extensive testing on the parents.

Yeah and I imagine IVF doctors would run into all kinds of PC crap if they tried to genetically test parents before treating them.

Originally posted by skeptic1

It could very well be genetics, but that would require extensive testing on the parents.

Except I don't think even that would do it, at least at our current ability level.

I think these are mostly epigenetic rather than strictly genetic.

That is, the DNA might be normal in terms of the order of the base pairs, but something's gone wrong with how strongly the genes are expressed. I don't know if they have any way of predicting that.

reply to post by americandingbat


Maybe not, but testing could be done to see if genetics play a prominent role in the defects that are being found at a higher rate in IVF babies.

I mean, I know that most everything boils down to genetics in the end, but cleft palates can either be genetic or due to environmental factors. If there is no history of palates on either side of the family in the past, it could be that an environmental factor (like fertility meds or maybe even the IVF process itself) increases the risk with IVF babies.

I wonder if they considered age. That women generally who turn to IVF are older, after years of trying. And are therefore more susceptible to birth defects anyways.

There is a saying when you are ready to deliver a baby that once they start interfering, the doctors have to keep interfering in the delivery.

And I have found this to be true.

I am sure that it would be the same with IVF, once you start artificially interferring with the embryo, many times it has to stay that way.