title: Assisted reproductive technologies and the risk of birth defects--a systematic review.
abstract: BACKGROUND
  The risk of birth defects in infants born following assisted reproductive technology (ART) treatment is a controversial question. Most publications examining the prevalence of birth defects in ICSI and IVF infants compared to spontaneously conceived infants have serious methodological limitations; despite this, most researchers have concluded that there is no increased risk.
  
  
  METHODS
  We carried out a systematic review to identify all papers published by March 2003 with data relating to the prevalence of birth defects in infants conceived following IVF and/or ICSI compared with spontaneously conceived infants. Independent expert reviewers used criteria defined a priori to determine whether studies were suitable for inclusion in a meta-analysis. Fixed effects meta-analysis was performed for all studies and reviewer-selected studies.
  
  
  RESULTS
  Twenty-five studies were identified for review. Two-thirds of these showed a 25% or greater increased risk of birth defects in ART infants. The results of meta-analyses of the seven reviewer-selected studies and of all 25 studies suggest a statistically significant 30-40% increased risk of birth defects associated with ART.
  
  
  CONCLUSIONS
  Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions. This information should be made available to couples seeking ART treatment.
authors.affiliation: Centre for Child Health Research, The University of Western Australia Telethon Institute for Child Health Research, West Perth, Western Australia 6872, Australia. michele@ichr.uwa.edu.au
authors.forename: Michèle
authors.initials: M
authors.lastname: Hansen
authors.forename: Carol
authors.initials: C
authors.lastname: Bower
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Milne
authors.forename: Nicholas
authors.initials: N
authors.lastname: de Klerk
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Kurinczuk
mesh_terms: D000013:Congenital Abnormalities / Q000453:epidemiology*; D005260:Female; D006801:Humans; D011247:Pregnancy; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects* / Q000706:statistics & numerical data*; D012307:Risk Factors