Will a child conceived through In Vitro Fertilization (IVF) with Intracytoplasmic Sperm Injection (ICSI) be less healthy or have fewer mental or motor skills than a naturally conceived child?

IVF with ICSI Children: Health and Development Outcomes

Children conceived through IVF with ICSI may have a slightly higher risk of adverse perinatal outcomes compared to naturally conceived children, but most will develop normally with no significant differences in mental or motor skills by school age. 1

Perinatal Outcomes

• IVF/ICSI singletons show significantly worse perinatal outcomes compared to naturally conceived children for parameters including prematurity, low birthweight, and other perinatal complications 1
• Studies from multiple countries consistently show that IVF/ICSI pregnancies have approximately 2.4 times higher risk of preterm birth compared to naturally conceived children 1
• A large Belgian study analyzing over 1 million singletons found that IVF/ICSI singletons had significantly worse outcomes for almost all investigated perinatal parameters compared to naturally conceived pregnancies 1

Physical Health in Early Childhood

• At 5 years of age, ICSI-conceived children show higher rates of major congenital malformations (odds ratio 2.77,95% CI 1.41-5.46) compared to naturally conceived children 2
• ICSI and IVF children are more likely than naturally conceived children to have experienced significant childhood illnesses, surgical operations, medical therapy, and hospital admissions 2
• The higher rate of malformations in ICSI children is partially due to an excess of urogenital system abnormalities in boys 2

Cognitive and Motor Development

• Early studies raised concerns about developmental delays at 1 year of age, with 17% of ICSI children showing mild or significant developmental delays compared to only 1-2% in naturally conceived children 3
• However, longer-term follow-up studies show more reassuring results:
  • By age 5, international collaborative studies found no clinically significant differences in cognitive development between ICSI, IVF, and naturally conceived children 4, 5
  • Motor development assessment at age 5 showed no differences between ICSI, IVF, and naturally conceived children 4
  • By age 8, some studies even found ICSI children obtaining slightly higher intelligence scores than spontaneously conceived children, though these differences were small (Cohen's d < 0.50) 6

Important Considerations and Nuances

• Maternal factors significantly influence outcomes:

  • Maternal educational level is an important factor accounting for variance in IQ between groups 6, 4
  • In the subgroup of firstborn children with older mothers (33-45 years), naturally conceived children scored slightly better on verbal and full-scale IQ tests than assisted reproductive technology children, though these differences were not clinically significant 4

• Multiple pregnancies carry additional risks:

  • Twin pregnancies resulting from assisted reproductive technologies show higher rates of neonatal mortality, assisted ventilation needs, and respiratory distress syndrome compared to naturally conceived twins 1
  • The focus on single embryo transfer in modern IVF practice helps mitigate these risks 1

Clinical Implications

• Parents considering IVF with ICSI should be counseled about the slightly increased risk of adverse perinatal outcomes, including prematurity and low birthweight 1
• Despite these initial challenges, the long-term cognitive and motor development of ICSI children appears comparable to naturally conceived children 6, 4, 5
• Regular pediatric follow-up is recommended for ICSI-conceived children, particularly in the first few years of life 2
• The benefits of achieving pregnancy through ICSI for couples with severe male factor infertility generally outweigh the small increased risks of adverse outcomes 1