title: The risk of major birth defects after intracytoplasmic sperm injection and in vitro fertilization.
abstract: BACKGROUND
  It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally.
  
  
  METHODS
  We obtained data from three registries in Western Australia on births, births after assisted conception, and major birth defects in infants born between 1993 and 1997. We assessed the prevalence of major birth defects diagnosed by one year of age in infants conceived naturally or with use of intracytoplasmic sperm injection or in vitro fertilization.
  
  
  RESULTS
  Twenty-six of the 301 infants conceived with intracytoplasmic sperm injection (8.6 percent) and 75 of the 837 infants conceived with in vitro fertilization (9.0 percent) had a major birth defect diagnosed by one year of age, as compared with 168 of the 4000 naturally conceived infants (4.2 percent; P<0.001 for the comparison between either type of technology and natural conception). As compared with natural conception, the odds ratio for a major birth defect by one year of age, after adjustment for maternal age and parity, the sex of the infant, and correlation between siblings, was 2.0 (95 percent confidence interval, 1.3 to 3.2) with intracytoplasmic sperm injection, and 2.0 (95 percent confidence interval, 1.5 to 2.9) with in vitro fertilization. Infants conceived with use of assisted reproductive technology were more likely than naturally conceived infants to have multiple major defects and to have chromosomal and musculoskeletal defects.
  
  
  CONCLUSIONS
  Infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have twice as high a risk of a major birth defect as naturally conceived infants.
authors.affiliation: Telethon Institute for Child Health Research and the Center for Child Health Research, University of Western Australia.
authors.forename: Michèle
authors.initials: M
authors.lastname: Hansen
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
authors.forename: Carol
authors.initials: C
authors.lastname: Bower
authors.forename: Sandra
authors.initials: S
authors.lastname: Webb
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology / Q000209:etiology; D000013:Congenital Abnormalities / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016017:Odds Ratio; D011247:Pregnancy; D011272:Pregnancy, Multiple; D015995:Prevalence; D012042:Registries; D012307:Risk Factors; D012494:Sampling Studies; D020554:Sperm Injections, Intracytoplasmic / Q000009:adverse effects*; D014904:Western Australia / Q000453:epidemiology