Malignant conditions in children born after assisted reproductive technology.
This article reviews the risks of childhood malignancies and imprinting disorders in children born after assisted reproductive technology (ART). It is recognized that there is a theoretical potential of developing an excess of malignancies in children born after ART. With the advancement and introduction of newer techniques in ART there is an increase in the micromanipulation of gametes and embryos in vitro and extended exposure to the in vitro environment. These include the use of gonadotropins for superovulation, intracytoplasmic sperm injection, blastocyst culture, assisted hatching, and preimplantation genetic diagnosis. Although these approaches aim to enhance pregnancy rates and its outcome, the risk of associated long-term health hazards cannot be disregarded. More recently there is some evidence suggesting a link between ART and epigenetic alterations leading to DNA modifications and imprinting disorders. Two of these genetic imprinting disorders that are known to cause birth defects and childhood malignancies, Beckwith-Wiedmann syndrome and Angelman syndrome have been associated with ART. Systemic reviews of the literature identified published studies, but were unable to identify the precise risks of imprinting disorders and childhood cancers in children conceived with ART. Overall, most studies have not shown any increase in the incidence of childhood cancers after ART. With more women resorting to ART, careful counseling should be offered to all couples especially those requiring intracytoplasmic sperm injection for abnormal sperm parameters.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this article, the reader should be able to distinguish for patients the lack of irrefutable evidence for an increased risk of childhood malignancies in children conceived using assisted reproductive technology (ART), explain potential mechanisms of injury to the gametes and/or embryo during ART which might predispose to childhood illness, and appraise future articles on this topic for credibility both to likelihood of true relationship to possible childhood cancers as well as biologic basis for potential relationship.
Neelanjana
Mukhopadhaya
M
Department of Obstetrics and Gynaecology, Luton and Dunstable NHS Trust, Luton, Bedfordshire, United Kingdom. n.m@doctors.org.uk
Sabaratnam
Arulkumaran
A
D002648:Child; D025063:Chromosome Disorders / Q000453:epidemiology / Q000209:etiology*; D019337:Hematologic Neoplasms / Q000453:epidemiology / Q000235:genetics; D006801:Humans; D007938:Leukemia / Q000453:epidemiology / Q000235:genetics; D009369:Neoplasms / Q000453:epidemiology* / Q000235:genetics; D009447:Neuroblastoma / Q000453:epidemiology / Q000235:genetics; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects*; D012175:Retinoblastoma / Q000453:epidemiology / Q000235:genetics