General health and hospital admissions in children born after ART: a population based linkage study

Lay summary

Approximately 1 in every 32 children born in the UK are conceived after IVF. This population is increasing annually and there are now over 8 million children born after IVF worldwide. Parents and healthcare providers have expressed concerns about the potential effects of this mode of conception on the children's long-term health. Previous studies suggested adverse effects including increased rates of congenital anomalies, prematurity, higher order births, and need for hospitalisation outside the neonatal period. However, much of the available evidence is often contradictory due to limitations such as small sample sizes, short follow-up periods, and the inability to determine whether the observed adverse health outcomes are solely due to ART treatment factors or the underlying parental subfertility.

Therefore, our research team at The Great Ormond Street Institute of Child Health, University College of London have designed a national population-based record-linkage study to examine the long-term health of children conceived via ART. We will use the Human Fertilization & Embryology Authority (HFEA) register to identify all children conceived via ART in the UK between August 1991 and September 2009, their naturally conceived siblings, and matched naturally conceived children from the general population. We will then use NHS medical records (cancer registration records and hospital records of care) to compare the risk of cancer, chronic conditions (e.g., cardiovascular disease), and early death between these groups. Using routine NHS data has several important methodological strengths, including national coverage, large sample size, robust markers of (sub)fertility, robust control group from the general population, longitudinal follow-up of health and mortality outcomes in children throughout their lifespan.

Public benefit statement

With 2% of babies now born through ART every year, this research is important for those babies, their mothers and those parents considering ART, the clinicians that treat these patients and the healthcare system as a whole. This study will benefit patients and the healthcare system by providing robust analysis to help remove some of these uncertainties. The results will be used to provide information to ART stakeholder groups, including fertility experts, patients wishing to undergo ART, children born after ART and their families and public health workers. Benefits from this study will include robust risk estimates for children born after assisted conception in comparison to both control groups (spontaneously conceived siblings and spontaneously conceived unrelated children). This information is crucial for counselling of families of ART children, couples who wish to undergo ART, informing practitioners of any increased health risks enabling early diagnosis, and future health service planning for this population.

Scientific publications

• Sutcliffe, A. G., Purkayastha, M., Brison, D. R., Nelson, S. M., Roberts, S. A., & Lawlor, D. A. (2022). General health in a cohort of children conceived after assisted reproductive technology in the United Kingdom: a population-based record-linkage study. American Journal of Obstetrics and Gynecology, 228(1):82.e1-82.e17.
• Purkayastha, M., Roberts, S. A., Gardiner, J., Brison, D. R., Nelson, S. M., Lawlor, D., Luke, B., & Sutcliffe, A. (2021). Cohort profile: A national, population-based cohort of children born after assisted conception in the UK (1992-2009): Methodology and birthweight analysis. BMJ Open 11: e050931.
• Williams, C. L., Bunch, K. J., Murphy, M. F. G., Stiller, C. A., Botting, B. J., Wallace, W. H., Davies, M. C., & Sutcliffe, A. G. (2018). Cancer risk in children born after donor ART. Human Reproduction, 33(1):140-146.

Data linkages

• Civil Registration of Birth
• Cancer registration data (National Cancer Registration and Analysis Service)
• Hospital care data [Personal Demographics Service, Hospital Episode Statistics (HES) Accident and Emergency, HES Admitted Patient Care, HES Critical Care, HES Outpatients datasets]