title: In vitro fertilization and the cloacal-bladder exstrophy-epispadias complex: is there an association?
abstract: OBJECTIVE
  The cloacal-bladder exstrophy-epispadias complex represents a collection of congenital malformations caused by failed mesenchymal development during the first trimester. We sought to determine whether the exstrophy-epispadias complex is overrepresented among children conceived by in vitro fertilization (IVF).
  
  
  METHODS
  The clinic charts of all patients born between 1998 and 2001 who presented to our institution with the exstrophy-epispadias complex were reviewed. Four patients conceived by IVF and born with exstrophy-epispadias were identified and telephone interviews were conducted with the parents. Statistical analysis using clinical data and available United States population data was performed.
  
  
  RESULTS
  Of 78 clinic patients with exstrophy-epispadias born during a 4-year period 4 were conceived using IVF. An estimated 12% to 14% of children born in the United States with the exstrophy-epispadias complex are evaluated annually at our institution. During the years 1997 to 2000, 112,137 children in the United States were conceived using IVF. According to published incidence data, approximately 5 children with exstrophy-epispadias would be expected among this entire population. Expected numbers of children in the United States conceived by IVF and born with exstrophy-epispadias during a 4-year period were calculated based on the observed number in our clinic population. A resulting 7.3-fold relative increase in incidence was determined (p = 0.0021).
  
  
  CONCLUSIONS
  The exstrophy-epispadias complex appears to occur more frequently in children conceived by in vitro fertilization.
authors.affiliation: Division of Epidemiology, Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
authors.forename: Hadley M
authors.initials: HM
authors.lastname: Wood
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Trock
authors.forename: John P
authors.initials: JP
authors.lastname: Gearhart
mesh_terms: D001746:Bladder Exstrophy / Q000453:epidemiology / Q000209:etiology*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004842:Epispadias / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment