title: A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception.
abstract: BACKGROUND
  Over a million children have been born from assisted conception worldwide. Newer techniques being introduced appear less and less 'natural', such as intracytoplasmic sperm injection (ICSI), but there is little information on these children beyond the neonatal period.
  
  
  METHODS
  540 ICSI conceived 5-year-old children from five European countries were comprehensively assessed, along with 538 matched naturally conceived children and 437 children conceived with standard IVF.
  
  
  RESULTS
  Of the 540 ICSI children examined, 63 (4.2%) had experienced a major congenital malformation. Compared with naturally conceived children, the odds of a major malformation were 2.77 (95% CI 1.41-5.46) for ICSI children and 1.80 (95% CI 0.85-3.81) for IVF children; these estimates were little affected by adjustment for socio-demographic factors. The higher rate observed in the ICSI group was due partially to an excess of malformations in the (boys') urogenital system. In addition, ICSI and IVF children were more likely than naturally conceived children to have had a significant childhood illness, to have had a surgical operation, to require medical therapy and to be admitted to hospital. A detailed physical examination revealed no further substantial differences between the groups, however.
  
  
  CONCLUSIONS
  Singleton ICSI and IVF 5-year-olds are more likely to need health care resources than naturally conceived children. Assessment of singleton ICSI and IVF children at 5 years of age was generally reassuring, however, we found that ICSI children presented with more major congenital malformations and both ICSI and IVF children were more likely to need health care resources than naturally conceived children. Ongoing monitoring of these children is therefore required.
authors.affiliation: Centrum Medische Gentica, Laarbeeklaan, 101, Brussels, Belgium.
authors.forename: M
authors.initials: M
authors.lastname: Bonduelle
authors.forename: U-B
authors.initials: UB
authors.lastname: Wennerholm
authors.forename: A
authors.initials: A
authors.lastname: Loft
authors.forename: B C
authors.initials: BC
authors.lastname: Tarlatzis
authors.forename: C
authors.initials: C
authors.lastname: Peters
authors.forename: S
authors.initials: S
authors.lastname: Henriet
authors.forename: C
authors.initials: C
authors.lastname: Mau
authors.forename: A
authors.initials: A
authors.lastname: Victorin-Cederquist
authors.forename: A
authors.initials: A
authors.lastname: Van Steirteghem
authors.forename: A
authors.initials: A
authors.lastname: Balaska
authors.forename: J R
authors.initials: JR
authors.lastname: Emberson
authors.forename: A G
authors.initials: AG
authors.lastname: Sutcliffe
mesh_terms: D002675:Child, Preschool; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005306:Fertilization; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006304:Health Status; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008423:Maternal Age; D009017:Morbidity; D010331:Paternal Age; D010808:Physical Examination; D020554:Sperm Injections, Intracytoplasmic / Q000706:statistics & numerical data*