title: Children born after assisted fertilization have an increased rate of major congenital anomalies.
abstract: OBJECTIVE
  To study the occurrence of major congenital anomalies (CAs) among children born after IVF (IVF, microinjections, and frozen embryo transfers) and after ovulation inductions with or without insemination (other assisted reproductive technologies [ART]).
  
  
  METHODS
  Register-based study.
  
  
  METHODS
  Data regarding CAs were obtained from the Register of Congenital Malformations.
  
  
  METHODS
  Children from IVF (n = 4,559), children from other ART (n = 4,467), and controls (n = 27,078, a random sample of naturally conceived children) from the Medical Birth Register.
  
  
  METHODS
  In vitro fertilization and other ART treatment in ordinary practice.
  
  
  METHODS
  Rate of major CAs. Children from IVF and other ART were compared with control children, both overall and by plurality, controlling for confounding factors by logistic regression.
  
  
  RESULTS
  For IVF children, the adjusted odds ratio (OR) was 1.3 (95% confidence interval [CI], 1.1-1.6). Stratifying by gender and plurality showed that the risk was only increased for boys, and the risk was decreased for multiple IVF girls (OR = 0.5, 95% CI 0.2-0.9). The crude OR of major CA for other ART children was 1.3 (95% CI 1.1-1.5), but adjusted differences by gender and plurality were statistically insignificant.
  
  
  CONCLUSIONS
  In vitro fertilization was associated with an increased risk for major CAs among singleton boys and a decreased risk among multiple girls. The risk after other ART was only slightly increased.
authors.affiliation: Health Services Research, National Research and Development Centre for Welfare and Health (STAKES), Helsinki, Finland. reija.klemetti@stakes.fi
authors.forename: Reija
authors.initials: R
authors.lastname: Klemetti
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.forename: Tiina
authors.initials: T
authors.lastname: Sevón
authors.forename: Sari
authors.initials: S
authors.lastname: Koivurova
authors.forename: Annukka
authors.initials: A
authors.lastname: Ritvanen
authors.forename: Elina
authors.initials: E
authors.lastname: Hemminki
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology*; D000328:Adult; D002648:Child; D016001:Confidence Intervals; D004624:Embryo Transfer / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects / Q000706:statistics & numerical data; D005387:Finland; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010062:Ovulation Induction / Q000009:adverse effects / Q000706:statistics & numerical data; D011247:Pregnancy; D012042:Registries / Q000706:statistics & numerical data; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects* / Q000706:statistics & numerical data*; D012307:Risk Factors; D012737:Sex Factors