Reacción a "Babies born through assisted reproduction have increased risk of serious heart defects, study finds"

This study investigated congenital cardiac malformations in pregnancies obtained with different assisted reproductive technologies (ART). The sample is large, covering 171,735 children born after ART in several Nordic countries (Denmark, Finland, Norway and Sweden) from 1984 to 2015. The authors assessed how many live-born children were diagnosed with a major or severe heart defect in utero or during their first year of life. They took into account other factors that may increase the risk of congenital heart defects, such as the child's year of birth, country of birth, the mother's age at delivery, whether the mother smoked during pregnancy, or whether the mother had diabetes or heart defects.

The results showed that heart defects were more common in babies born after ART compared to those conceived without treatment (absolute risk of 1.84% vs. 1.15%). This risk was similar regardless of the type of ART (IVF or ICSI, fresh or frozen embryos). They also showed that the risk of ART births was higher for multiple births compared to singleton births (2.47% vs. 1.62%), which is to be expected and widely demonstrated, as the risk of malformations in multiple pregnancies is always higher than in singleton pregnancies, both in ART-born and naturally conceived children.

If we look at the latest European ART registry published in 2023, which reports the data recorded in 2019 by country, we can observe several curious things The number of clinics (registration is compulsory in these countries as well as in Spain) is 65 adding the 4 countries of the study and, only in Spain, it is 244. In our country there is a higher rate of multiple pregnancies than in the Nordic countries, a fact that has been the case for many years, since in these countries it is not allowed to transfer more than one embryo in most cases. Another striking fact is that in Spain 22,190 cycles of pre-implantation genetic screening are performed, while the sum of this type of cycles in the 4 countries of the study is 1,373, a fact that may be interesting due to the fact that genetically healthy embryos are selected before transferring them to the uterus of the future mother.

In 2013 we published a study in Spain from the Embryo Health Group which analysed 8,682 pregnancies obtained with ART and the neonatal malformations, prematurity and stillbirths in both single and multiple pregnancies of children born after these pregnancies. Malformations (not only cardiac, but all those classified according to the ICD 10 code of the WHO) were detected in 0.83 % of our newborns and there were no differences in malformations between single and multiple pregnancies, this percentage being similar to that of spontaneously conceived children.

I believe that the study should not be so alarmist, as there are no significant differences between children born after spontaneous pregnancies and those born after ART, especially since we are already starting from people with an infertility problem and who do not achieve pregnancy in a natural way. Prospective parents should be informed of the risks of the children born, as we do in our country, but without scaring them. Perhaps the Nordic countries should offer more pre-implantation genetic diagnosis techniques and do more genetic screening of patients before undergoing ART. It should be taken into account that the study has been done in countries with a low number of clinics, data on pregnancies from 1984 to 2015 have been analysed and there have been very significant changes in ART (improved conditions in IVF laboratories, culture media adapted to different situations, super-efficient cryopreservation techniques, improved embryo selection thanks to algorithms created after morphokinetic studies, implementation of quality systems, etc.) and that in Spain and other countries, the study has been done in countries with a low number of clinics, data on pregnancies from 1984 to 2015 have been analysed. ) and that in Spain and other countries the studies of malformations that have been carried out have not demonstrated higher rates of any malformation in children born with ART than in spontaneous pregnancies due to gamete manipulation techniques.

We are lucky to live in a country with one of the best pregnancy rates in Europe and proof of this is that half of the European cycles of oocyte donation or PGT are carried out here, as we are a leading country in reproductive tourism, thanks to a broad law on reproduction and the good professionals we have in this speciality in Spain.