SAFETY OF ART

Assisted reproductive technologies (ART) are increasingly used worldwide to overcome infertility problems, and it has been estimated that more than one million children have been born relying on these techniques. ART births now account for 1–3 percent of all births in developed countries. ART have considerably evolved since the beginning, and now they include controlled ovarian stimulation, (immature) gamete retrieval and manipulation, standard in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), (extended) embryo culture, freezing/thawing of embryos, embryo biopsy in cases of preimplantation genetic diagnosis, and more recently in vitro maturation of oocytes and techniques of cryopreservation of testicular/ovarian tissues. There has been concern about the health of the children conceived ever since the birth of the first IVF baby in 1978 (1) and certainly after the introduction of the more invasive ICSI procedure in the early 1990s. The safety aspect has been addressed in various epidemiological studies of children conceived by ART as well as experimental studies. The follow-up studies including a review by Rizk et al. of the major congenital anomalies in the first 1,000 babies conceived by IVF have shown that generally ART-conceived children are as healthy as naturally conceived children (1), except that ART may increase the risk of a few outcomes. There is accumulating evidence of an increase in chromosomal abnormalities in ICSI children, as well as evidence for an increase in malformation rate and in the number of singleton children with a low birth weight in the IVF/ICSI population compared to the general population.