title: Academic performance in adolescents born after ART-a nationwide registry-based cohort study.
abstract: Is academic performance in adolescents aged 15-16 years and conceived after ART, measured as test scores in ninth grade, comparable to that for spontaneously conceived (SC) adolescents?
  
  
  
  ART singletons had a significantly lower mean test score in the adjusted analysis when compared with SC singletons, yet the differences were small and probably not of clinical relevance.
  
  
  
  Previous studies have shown similar intelligence quotient (IQ) levels in ART and SC children, but only a few have been on adolescents. Academic performance measured with standardized national tests has not previously been explored in a complete national cohort of adolescents conceived after ART.
  
  
  
  A Danish national registry-based cohort including all 4766 ART adolescents (n = 2836 singletons and n = 1930 twins) born in 1995-1998 were compared with two SC control cohorts: a randomly selected singleton population (n = 5660) and all twins (n = 7064) born from 1995 to 1998 in Denmark. Nine children who died during the follow-up period were excluded from the study.
  
  
  
  Mean test scores on a 7-point-marking scale from -3 to 12 were compared, and adjustments were made for relevant reproductive and socio-demographic covariates including occupational and educational level of the parents.
  
  
  
  The crude mean test score was higher in both ART singletons and ART twins compared with SC adolescents. The crude mean differences were +0.41 (95% CI 0.30-0.53) and +0.45 (95% CI 0.28-0.62) between ART and SC singletons and between ART and SC twins, respectively. However, the adjusted mean overall test score was significantly lower for ART singletons compared with SC singletons (adjusted mean difference -0.15 (95% CI -0.29-(-0.02))). For comparison, the adjusted mean difference was +2.05 (95% CI 1.82-2.28) between the highest and the lowest parental educational level, suggesting that the effect of ART is weak compared with the conventional predictors. The adjusted analyses showed significantly lower mean test scores in mathematics and physics/chemistry for ART singletons compared with SC singletons. Comparing ART twins with SC twins yielded no difference in academic performance in the adjusted analyses. Similar crude and adjusted overall mean test scores were found when comparing ART singletons and ART twins.
  
  
  
  Missing data on educational test scores occurred in 6.6% of adolescents aged 15-16 years for the birth cohorts 1995-1997, where all of the children according to their age should have passed the ninth grade exam at the time of data retrieval. As sensitivity analyses yielded no significant difference in the adjusted risk of having missing test scores between any of the groups, it is unlikely that this should bias our results. Adjustment for body mass index and smoking during pregnancy was not possible.
  
  
  
  As our results are based on national data, our findings can be applied to other populations. The findings of this paper suggest that a possible small negative effect of parental subfertility or ART treatment is counterbalanced by the higher educational level in the ART parents.
  
  
  
  The Danish Medical Association in Copenhagen (KMS) funded this study with a scholarship grant. None of the authors had any competing interests.
  
  
  
  704676.
authors.affiliation: Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark annelrke@gmail.com.
authors.forename: A L
authors.initials: AL
authors.lastname: Spangmose
authors.affiliation: Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark.
authors.forename: S S
authors.initials: SS
authors.lastname: Malchau
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Schmidt
authors.affiliation: Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: D
authors.initials: D
authors.lastname: Vassard
authors.affiliation: Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark.
authors.forename: S
authors.initials: S
authors.lastname: Rasmussen
authors.affiliation: Fertility Clinic Section 4071, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Loft
authors.affiliation: Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: J
authors.initials: J
authors.lastname: Forman
authors.affiliation: Department of Obstetrics and Gynaecology, Fertility Clinic, Copenhagen University Hospital, Hvidovre, Kettegaard Allé 30, 2650 Hvidovre, Copenhagen, Denmark.
authors.forename: A
authors.initials: A
authors.lastname: Pinborg
mesh_terms: D000073978:Academic Performance; D000293:Adolescent; D015331:Cohort Studies; D003718:Denmark; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D059285:Pregnancy, Twin; D012042:Registries; D027724:Reproductive Techniques, Assisted; D012574:Schools; D014427:Twins
keywords: ART; ICSI; IVF; academic performance; assisted reproductive technologies; cognitive development; infertility; intelligence; subfertility