Early Autism Spectrum Disorders in Children Born to Fertile, Subfertile, and ART-Treated Women

Abstract

Introduction: We examined the prevalence of autism spectrum disorders (ASDs) in Massachusetts (MA) comparing children born via assisted reproductive technology (ART) and children born to women with indicators of subfertility but no ART (Subfertile), to children born to women with neither ART nor indicators of subfertility (Fertile). We assessed the direct, indirect, and total effects of ART and subfertility on ASD among singletons.

Methods: This study included 10,147 ART, 8072 Subfertile and 441,898 Fertile MA resident births from the MA Outcome Study of ART (MOSART) database linked with Early Intervention program participation data. ART included fresh in vitro fertilization (IVF), fresh intracytoplasmic sperm injection (ICSI), and frozen embryo transfer. We estimated the prevalence of ASD by fertility group. We used logistic regression to assess the natural direct effect (NDE), natural indirect effect (NIE) through preterm birth, and total effects of each fertility group on ASD.

Results: The NDE indicated that, compared to the Fertile group, the odds of ASD were not statistically higher in the ART (OR_NDE 1.07; 95% CI 0.88-1.30), Subfertile (OR_NDE 1.11; 95% CI 0.89-1.38), IVF (OR_NDE 0.91; 95% CI 0.68-1.22), or ICSI (OR_NDE 1.13; 95% CI 0.84-1.51) groups, even if the rate of preterm birth was the same across all groups. The total effect (product of NDE and NIE) was not significant for ART (OR_{Total Effect} 1.08; 95% CI 0.89-1.30), Subfertile (OR_{Total Effect} 1.11; 95% CI 0.89-1.38), IVF (OR_{Total Effect} 0.92; 95% CI 0.69-1.23), or ICSI (OR_{Total Effect} 1.13; 95% CI 0.84-1.52).

Conclusion: Compared to children born to Fertile women, children born to ART, ICSI, or IVF, or Subfertile women are not at increased risk of receiving an ASD diagnosis.

Keywords: Assisted reproductive technology; Autism spectrum disorders; In vitro fertilization; Intracytoplasmic sperm injection; MOSART; Subfertile.