Educational outcomes in children born after assisted reproductive technology: a population-based linkage study

Lay summary

Nearly 1 in 32 children in the UK are born to parents who have benefited from fertility (i.e., assisted reproductive treatments- ART) treatments and this number is increasing annually. Some of these parents have questioned whether their children are different in terms of developmental and educational outcomes. Therefore, it is important for us to understand whether this growing population of children are at higher risk of developing such problems as we can then identify and manage them in a timely manner and also provide appropriate and reliable information to couples considering ART.

There are various reasons why the development of ART-conceived children may differ from those conceived naturally. For example, the former exhibit a slightly increased risk of being smaller in size, being born prematurely, or being part of multiple births such as twins (as multiple embryo transfers were commonly used in the past) compared to the latter, thereby increasing their risk of poorer health and neurodevelopmental outcomes. Exposure of ART embryos to in-vitro environments and high doses of hormones can have important effects on the developing embryo’s brain. However, existing studies that investigate neurodevelopmental outcomes in ART children have various limitations including limited examination of children beyond preschool age (i.e., 5 years), small study populations, and various methodological weaknesses.

Therefore, our research team at The Great Ormond Street Institute of Child Health, University College of London will address this gap in scientific knowledge by comparing the educational and behavioural outcomes from ages 4 to 18 years between ART-conceived children born in the UK between 1992 and 2009 and two comparison groups of related (i.e., siblings) and unrelated (i.e., school-matched) naturally conceived children. This will be done by linking several large existing national datasets, the Human Fertilisation and Embryology Authority (HFEA) Register and the National Pupil Database (NPD).

Public benefit statement

Approximately 1 in 7 couples in the UK experience difficulty in conceiving children naturally and ART can help these couples considerably. The usage of ART has increased rapidly, as evidenced by an increase in the proportion of ART-conceived children in the UK from 0.3% in 1992 to 2.2% in 2012. This increase highlights the importance of monitoring the long-term health and development of these children. The findings of this study will have wider benefits to various ART stakeholder groups, including fertility experts, couples wishing to undergo ART, children born after ART and their families and public health providers. It will also address the gap in scientific knowledge regarding the educational attainment of these children, potentially facilitating early diagnosis and targeted intervention. Data linkage using existing national datasets is the least intrusive, most efficient, and only feasible methodology for adequately investigating this research question with a sufficiently large and representative sample size.

Data linkages

• Civil Registration of Birth
• Indices of Multiple Deprivation
• National Pupil Database (Department for Education)