Catholic Bioethics
IN VITRO
FERTILIZATION
 

  Faust: Wagner creates the homunculus.


1.  BIOLOGY and TECHNOLOGY of In Vitro Fertilization

2. THE MAGISTERIUM on IVF: 2.1 Donum Vitae; 2.2. Dignitas Personae; 2.3. Humanae Vitae; 2.4. Theology of the Body; 2.5. Evangelium Vitae

3. COMPLICATIONS and SIDE-EFFECTS of  IVF;  3.1. Ovarian Hyperstimulation; 3.2. Birth Defects; 3.3 Multiple Gestations

4. EXAMPLES of ARTICLES on BIRTH DEFECTS and IVF


1.  BIOLOGY and TECHNOLOGY of In Vitro Fertilization

 

 


1. BIOLOGY and TECHNOLOGY
of In Vitro Fertilization

 

 

 


As Ford has noted (The Prenatal Person, ch. 6), the most frequently used treatment for infertility in the developed world is In Vitro Fertilization followed by Embryo Transfer.  The commercial aspects of this procedure can be best appreciated visiting the website of one of the centers that offer this treatment, for example: http://www.advancedfertility.com , the Advanced Fertility Center of Chicago.  Note in particular the costs, the various "packages" available at different cost, and the extent to which the risks and side-effects of the treatment are described (or not mentioned).  Try searching for GIFT on their site, (e.g.:https://www.advancedfertility.com/blastocyst.htm) and note how vigorously it is discouraged. Note also their solicitation for egg-donors of various ethnic backgrounds. 

1. Harvesting egg and sperm

2. Fertilization

3. Incubation to blastocyst-stage (7-10 days)

4. Transfer of embryo to uterus


 

 


1.1 Retrieving Oocytes after Ovarian Stimulation
 

 

 

 1.1.1. Aspiration of a hyperstimulated ovary.  1.1.2. Ultrasound probe locates stimulated follicle

 

 1.1.3. Aspiration of follicle.

 

 


1.2. Fertilization
 

 

 

 1.2.1. Spermatazoa are mixed with the harvested oocytes.

Intra-Cytoplasmic Sperm Injection


 1.2.2. Artist's rendering of Intra-Cytoplasmic Sperm Injection

 


 

 


1.3. Incubation of Embryos to Blastocyst Stage
 

 

 

1.3.1. IVF Incubator

 1.3.2.   1. Fertilized (bovine) oocyte;   5. Morula;    8. Blastocyst

 

 

 


1.4. Transfer of Embryos to the Uterus
 

 

 

 1.4.1. Embryos transferred from syringe to uterus

 


2. THE MAGISTERIUM on IVF:

 

 


2. THE CATHOLIC MAGISTERIUM
on In Vitro Fertilization

 

 

 

The moral significance and implications of in vitro fertilization were described in detail by the Congregation for the Doctrine of the Faith in the 1987 instruction, Donum Vitae.  The intrinsically immoral nature of in vitro fertilization was reiterated, together with a specific condemnation of intracytoplasmic sperm injection, in the 2008 instruction, Dignitas Personae.


 


  2.1
C.D.F. Donum Vitae (1987)
 

 


II. The connection between in vitro fertilization and the voluntary destruction of human embryos occurs too often. This is significant: through these procedures, with apparently contrary purposes, life and death are subjected to the decision of man, who thus sets himself up as the giver of life and death by decree. This dynamic of violence and domination may remain unnoticed by those very individuals who, in wishing to utilize this procedure, become subject to it themselves. The facts recorded and the cold logic which links them must be taken into consideration for a moral judgment on IVF and ET (in vitro fertilization and embryo transfer): the abortion-mentality which has made this procedure possible thus leads, whether one wants it or not, to man’s domination over the life and death of his fellow human beings and can lead to a system of radical eugenics Nexus qui inter fecundationem in vitro et voluntariam peremptionem humanorum embryonum intercedit, nimio plus usu venit. Id est significationis plenum : hisce enim artibus, quamquam contraria appetuntur, mors et vita tandem in hominis voluntatem rediguntur, qui hoc modo se vitae necisque auctorem constituit, idque alieno iussu. Haec dynamica conexio violentiae ac dominii fortasse nec ab iis quidem percipitur, qui hisce artibus uti volentes, eisdem revera deserviunt. Quare tum facta supra memorata, tum illorum coniunctio, humanitatis expers, plane considerentur oportet, ut morale iudicium fiat de methodo FIVET (hoc est de fecundatione ovuli in vitro et de embryonis translatione) : nam mentis habitus proclivis ad abortum, qui tandem ad haec conduxit, inducit etiam, velimus nolimus, ad dominium hominis in vita ac morte proximorum, ex quo nasci potest « eugenismus » ad extremam formam adductus.

[II.B.5] The Church remain opposed from the moral point of view to homologous ‘in vitro’ fertilization. Such fertilization is in itself illicit [intrisicus illicita] and in opposition to the dignity of procreation and of the conjugal union, even when everything is done to avoid the death of the human embryo.

 Ecclesiae iudicium perstat contrariurn fecundationi homologae in vitro: haec est intrinsecus illicita, ac dignitati procreattionis et coniunctionis coniugalis tunc etiam repugnat, cum illi omittitur ut embryonis mors praecaveatur.

Just as the Church condemns induced abortion, so she also forbids acts against the life of these human beings. It is a duty to condemn the particular gravity of the voluntary destruction of human embryos obtained ‘in vitro’ for the sole purpose of research, either by means of artificial insemination of by means of “twin fission”. Quare Ecclesia, sicut abortum procuratum damnat, ita etiam prohibet, ne vita harum humanarum creaturarum attentetur. Conscientiae officium postulat, ut palam denuntietur peculiaris gravitas voluntariae interfectionis embryonum humanorum, qui in vitro obtenti sunt ad solum investigationis finem, ope sive fecundationis artificialis, sive <<fissionis gemellaris >>
By acting in this way the researcher usurps the place of God; and, even though he may be unaware of this, he sets himself up as the master of the destiny of others inasmuch as he arbitrarily chooses whom he will allow to live and whom he will send to death and kills defenceless human beings.  », quam vocant. Hac agendi ratione investigator se in locum Dei substituit atque, licet inconscius, se efficit dominum aliorum sortis, quippe qui arbitratu suo decernat quis vivat et quis morte afficiatur, idemque creaturas humanas interficiat, quae defensione carent.
   
II B 5. Homologous IVF and ET is brought about outside the bodies of the couple through actions of third parties whose competence and technical activity determine the success of the procedure. Such fertilization entrusts the life and identity of the embryo into the power of doctors and biologists and establishes the domination of technology over the origin and destiny of the human person. Such a relationship of domination is in itself contrary to the dignity and equality that must be common to parents and children Methodus FIVET homologa ad actum deducitur extra coniugum corpus, opera aliorum, a quorum scientia atque technica arte prosper exitus interventus dependet; eadem vitam identitatemque embryonum humanorum in potestatem redegit medicorum atque biologorum, sicque rei technicae dominatum quemdam in personae humanae originem et sortem instaurat. Huiusmodi dominatus suapte natura contradicit dignitati et aequalitati, quae parentibus et filiis communes esse debent.
Conception in vitro is the result of the technical action which presides over fertilization. Such fertilization is neither in fact achieved nor positively willed as the expression and fruit of a specific act of the conjugal union. In homologous IVF and ET, therefore, even if it is considered in the context of ‘de facto’ existing sexual relations, the generation of the human person is objectively deprived of its proper perfection: namely, that of being the result and fruit of a conjugal act in which the spouses can become “cooperators with God for giving life to a new person Conceptio in vitro est effectus actionis technicae, per quem evenit fecundatio ; ea autem neque re vera obtinetur, neque consulto appetitur tamquam manifestatio ac fructus actus qui est proprius coniunctionis coniugalis. In methodo FIVET homologa, igitur, etsi consideretur in contextu actuum coniugalium qui reapse exsistunt, nihilominus generatio personae humanae obiective destituitur perfectione sibi propria, qua scilicet illa est terminus et fructus actus coniugalis, per quem coniuges fieri possunt « Dei cooperatores tradendo vitae donum novo alicui homini )).*°
   

 


  2.2.
C.D.F. Dignitas Personae (2008)
 

 


14. [...] all techniques of in vitro fertilization proceed as if the human embryo were simply a mass of cells to be used, selected and discarded. [...]15. the number of embryos sacrificed is extremely high. [...] in many cases the abandonment, destruction and loss of embryos are foreseen and willed  [...] the practice of multiple embryo transfer implies a purely utilitarian treatment of embryos. 


16. The blithe acceptance of the enormous number of abortions involved in the process of in vitro fertilization vividly illustrates how the replacement of the conjugal act by a technical procedure – in addition to being in contradiction with the respect that is due to procreation as something that cannot be reduced to mere reproduction – leads to a weakening of the respect owed to every human being. 17. Intracytoplasmic sperm injection (ICSI) is morally illicit, [in that it] causes a complete separation between procreation and the conjugal act


 

 


 

THESE condemnations represent the application of principles earlier enumerated concerning the control and domination of nature in general and of human reproduction in particular:

 


 


  2.3.
Pope Paul VI, Humanæ Vitæ: (1968)
 

 


2.[4]  Finally, and above all, it must be noted that because Man has made such remarkable progress in controlling  [moderandis] the forces of nature and in rationally organizing them, he also strives to extend this control [moderationem] to the whole of his life: that is, to his body, to the powers of his mind [ad sui animi vires], to his social life, and even to the laws that regulate the propagation of life.

Denique illud praesertim animadvertendum est, hominem tam mirifice profecisse in naturae viribus cum moderandis tum ad rationem scite componendis, ut hanc moderationem ad totam suam vitam proferre conetur : hoe est, ad suum corpus, ad sui animi vires, ad vitam socialem, ad ipsasque leges propagationem vitae regentes.
17. Therefore, if we do not want the mission [officium] of procreating human life to be conceded to the arbitrary decisions of Men, we need to recognize that there are some limits to the power of Man over his own body and over the natural operations [munera] of the body, that ought not to be transgressed. No one, neither a private individual nor a public authority, ought to violate these limits. For these limits are derived from the reverence owed to the whole human body and its natural operations [naturalibus muneribus], according to the principles acknowledged above, and according to a proper understanding of the so-called principle of totality, as explained by Our Predecessor, Pius XII.47 Quare, nisi velimus ut procreandae vitae officium hominum arbitratui concedatur, necessario aliquos fines, quos ultra pro­gredi non liceat, agnoscamus oportet illi potestati, quam homo in proprium corpus in eiusque naturalia munera habere po­test; fines, dicimus, quas nemini, sive privato sive publica auctoritate praedito, violare licet. Qui limites non aliam ob causam statuuntur, quam ob reverentiam, quae toti humano corpori eiusque naturalibus muneribus debetur, secundum principia, quae supra memoravimus, et rectam intellegentiam principh totalitatis, ut aiunt, quod Decessor Noster v. m. Pius XII illustravit.
21. Moral family planning requires that spouses recognize and value the true goods of life and the family, and also that they acquire the habit of complete mastery [moderari]of themselves and their desires [motibus]. In order to control the drives of nature, the spouses need to become self-denying [asceseos] through using their reason and free will. Only then will the manifestations of love appropriate for married couples be what they ought to be. Self-mastery is especially necessary for those who practice periodic abstention. 21. Recta autem et honesta nasciturae prolis ordinatio id primum a coniugibus postulat, ut vera vitae familiaeque bona penitus agnoscant et existiment, itemque sibi ac suis motibus perfecte moderari consuescant. Nihil profecto est dubii, quin naturae impetibus, rationis liberaeque voluntatis ope, imperare asceseos sit opus, ut nempe amoris significationes, coniugalis vitae propriae, cum recto ordine congruant; quod praesertim ad usum continentiae, certis temporis intervallis servandae, requiritur.

 


  2.4.
Bl. Pope John Paul II, The Theology of the Body (1984):
 

 


   6. [119] General Audience of 22 August 1984, [Ws. 123, pp. 630-633; ToB 396-399]

1. [...] This extension of the sphere of the means of “domination of the forces of nature” menaces the human person for whom the method of “self-mastery” is and remains specific. The mastery of self corresponds to the fundamental constitution of the person; it is indeed a “natural” method. On the contrary, the resort to artificial means destroys the constitutive dimension of the person. It deprives man of the subjectivity proper to him and makes him an object of manipulation.


 


  2.5.
Bl. Pope John Paul II, Evangelium Vitae (1995):
 

 


Be fruitful and multiply, and fill the earth and subdue it
         
(Gen 1:28): man’s responsibility for life  

“Crescite et multiplicamini et replete terram et subicite eam” (Gen. 1, 28): hominis de vita officia

42. [...]As one called to till and look after the garden of the world (cf. Gen 2:15), [...]

42.Ad mundi hortum colendum tutandumque vocatus (Cfr. Gen. 2, 15) [...]

the dominion granted to man by the Creator is not an absolute power, nor can one speak of a freedom to ‘use and misuse’, or to dispose of things as one pleases. The limitation imposed from the beginning by the Creator himself and expressed symbolically by the prohibition not to ‘eat of the fruit of the tree’ (cf. Gen 2:16-17) shows clearly enough that, when it comes to the natural world, we are subject not only to biological laws but also to moral ones, which cannot be violated with impunity”.[2]    

  “dominium a Creatore homini datum... non est absolutum, nec potest utendi et abutendi arbitrium vocari, vel ex commodo res disponendi. Modus, quem inde a principio ipse Creator homini imposuit quique symbolica ratione exprimitur per interdictionem comedendi de ligno (Cfr. Gen. 2, 16-17), satis clare ostendit in universitate naturae visibilis... nos legibus esse subiectos, non solum biologicis, verum etiam et moralibus, quae impune violari nequeunt” (IOANNIS PAULU PP. II Sollicitudo Rei Socialis, 34).

 

 

 

 

 


3. COMPLICATIONS and SIDE-EFFECTS of  IVF

 

 


3. COMPLICATIONS and SIDE EFFECTS
of In Vitro Fertilization

 

 

 


The subject of complications and side-effects of In Vitro Fertilization and Embryo Transfer is complex and controversial.  Identical scientific studies are often cited by individuals who hold opposing points of view, one side claiming that IVF is safe for mother and offspring, with the other maintaining that the same studies deminstrate significant morbidity for both mothers who use IVF and for their resultant children. The following side-effects are well-documented and indisputable.


   3.1 Ovarian Hyperstimulation Syndrome


The drugs (gonadatropins) used to induce multiple simultaneous ovulations can cause ovarian hyperstimulation syndrome, a potentially dangerous condition that can cause edema (fluid retention) and death. 

[...] significant ovarian hyperstimulation syndrome (OHSS) occurs in approximately 0.5% of women receiving gonadotropins. OHSS can be life-threatening, causing massive fluid shifts, ascites, pleural effusion, electrolyte disturbances, and thromboembolism.

Lentz, G., Comprehensive Gynecology, 6th ed. ( 2012, Mosby, Elsevier). p. 882

Supporters of IVF claim that lower doses of the drugs used to stimulate the ovaries can avoid this complication; however the lower dose-regimen results in the production of fewer eggs, and may necessitate more cycles of IVF.

It is accepted that excessive ovarian stimulation leads to the risk of hyperstimulation and a poor outcome, including the possibility of oocyte aneuploidy and a disordered endometrium. Nevertheless, obtaining an adequate number of mature oocytes leads to having more embryos available for transfer and possible cryopreservation.

Lenz, Comprehensive Gynecology, 6th ed. (2012), p. 892

In July of 2012 an article was published in the New York Times on Ovarian Hyperstimulation in fertility treatment.


   3.2. Birth Defects


Studies that have demonstrated an increased incidence of birth defects associated with IVF have been interpreted by some as an indictment of the practice of Intracytoplasmic Sperm Injection (ICI), rather than reflecting some more fundamental flaw in the overall practice of IVF.  It is possible that defective sperm which would otherwise been incapable of effecting fertilization are sometimes introduced into the harvested oocytes by ICI.  Other factors that increase the incidence of birth defects include advanced maternal age and multiple gestation (twins, triplets, quadruplets, etc.), as described in the next section.


   3.3 Multiple Gestations


A frequent complication of IVF is multiple gestation, the situation in which a woman finds herself pregnant with more than one child.  In order to increase the likelihood of pregnancy following IVF, multiple embryos are invariably created: some are transferred to the mother, while others are frozen against possible future need.  If all the embryos successfully implant and develop, there is risk, not only to the mother, but to the infants themselves:

Women pregnant with multiples not only have higher risks for developing certain conditions but also are more likely to have more severe manifestations of those conditions

Gabbe, S., Obstetrics: Normal and Problem Pregnancies, 6th ed.. (2012 Saunders, Elsevier), p. 667.

 

Babies who are products of multiple gestations have higher rates of low birthweight, earlier gestational age at delivery, and higher rates of neonatal and infant death and cerebral palsy.

Gabbe, S., Obstetrics, 6th ed.. (2012), p. 678.

 


4. EXAMPLES of ARTICLES on BIRTH DEFECTS and IVF

 

 


4. REPRESENTATIVE RECENT ARTICLES
on
BIRTH DEFECTS and In Vitro Fertilization
 

 

 


 

 

4.0. A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception.
M. Bonduelle, U.-B. Wennerholm, et. al. Human Reproduction v.20, 2004, Issue 2, 413-419.
 

 

 

 BACKGROUND: Over a million children have been born from assisted conception worldwide. Newer techniques being introduced appear less and less ‘natural’, such as intracytoplasmic sperm injection (ICSI), but there is little information on these children beyond the neonatal period.

METHODS: 540 ICSI conceived 5-year-old children from five European countries were comprehensively assessed, along with 538 matched naturally conceived children and 437 children conceived with standard IVF.

RESULTS: Of the 540 ICSI children examined, 63 (4.2%) had experienced a major congenital malformation. Compared with naturally conceived children, the odds of a major malformation were 2.77 (95% CI 1.41–5.46) for ICSI children and 1.80 (95% CI 0.85–3.81) for IVF children; these estimates were little affected by adjustment for socio-demographic factors. The higher rate observed in the ICSI group was due partially to an excess of malformations in the (boys') urogenital system. In addition, ICSI and IVF children were more likely than naturally conceived children to have had a significant childhood illness, to have had a surgical operation, to require medical therapy and to be admitted to hospital. A detailed physical examination revealed no further substantial differences between the groups, however.

CONCLUSIONS: Singleton ICSI and IVF 5-year-olds are more likely to need health care resources than naturally conceived children. Assessment of singleton ICSI and IVF children at 5 years of age was generally reassuring, however, we found that ICSI children presented with more major congenital malformations and both ICSI and IVF children were more likely to need health care resources than naturally conceived children. Ongoing monitoring of these children is therefore required.

 


 

 

4.1. In vitro fertilization and risk of childhood leukemia in Greece and Sweden.
 Petridou, E.T., Pediatr Blood Cancer, 01-JUN-2012; 58(6): 930-6.
 

 

 

 

BACKGROUND: Cancer risk in children born after in vitro fertilization (IVF) remains largely unknown. We aimed to investigate risk of leukemia and lymphoma following IVF using two nationwide datasets.

METHODS: The hospital-based case-control study in Greece derived from the National Registry for Childhood Hematological Malignancies (1996-2008, 814 leukemia and 277 lymphoma incident cases with their 1:1 matched controls). The Swedish case-control study was nested in the Swedish Medical Birth Register (MBR) (1995-2007, 520 leukemia and 71 lymphoma cases with their 5,200 and 710 matched controls) with ascertainment of incident cancer cases in the National Cancer Register. Study-specific and combined odds ratios (OR) were estimated using conditional logistic regression, with adjustment for possible risk factors.

RESULTS: Nationwide studies pointed to similar size excess risk of leukemia following IVF, but to a null association between IVF and lymphoma. The proportion of leukemia cases conceived through IVF was 3% in Greece and 2.7% in Sweden; prevalence of IVF in matched controls was 1.8% and 1.6%, respectively. In combined multivariable analyses, the increased risk of leukemia was confined to age below 3.8 years (OR 2.21; 95% confidence interval, CI: 1.27-3.85) and to acute lymphoblastic leukemia (ALL) (OR 1.77; 95% CI: 1.06-2.95) with no sufficient evidence of excess risk for other leukemias (OR 1.34; 95% CI: 0.38-4.69). Following IVF, OR for ALL was 2.58 (95% CI: 1.37-4.84) before age 3.8 and 4.29 (95% CI: 1.49-12.37) before age 2 years.

CONCLUSIONS: IVF seems to be associated with increased risk of early onset acute lymphoblastic leukemia in the offspring.


 

4.2. Cancer risk in children and young adults conceived by in vitro fertilization.
Källén, B., Pediatrics - 01-AUG-2010; 126(2): 270-6
 

 

 

 

OBJECTIVES: Studies conducted so far have found no statistically significant increased risk for cancer among children who are born after in vitro fertilization (IVF).
METHODS: We followed 26,692 children who were born after IVF during the years 1982-2005 by using the Swedish Cancer Register and compared the number of children who had cancer and were born after IVF with children who were not conceived by IVF. Adjustment was made for year of birth.
RESULTS: Maternal age, parity, smoking, subfertility, previous miscarriages, BMI, and multiple births did not significantly affect cancer risk in offspring. High birth weight, premature delivery, and the presence of respiratory diagnoses and low Apgar score were risk factors for cancer. We identified 53 cases of cancer in children who were born after IVF against 38 expected cases: 18 of them with hematologic cancer (15 of them acute lymphoblastic leukemia), 17 with eye or central nervous system tumors, and 12 with other solid cancers. There were 6 cases of Langerhans histiocytosis against 1.0 expected. The total cancer risk estimate was 1.42 (95% confidence interval: 1.09-1.87)
CONCLUSIONS: We found a moderately increased risk for cancer in children who were conceived by IVF. Putative intermediary factors could be preterm birth and neonatal asphyxia.
 

 

4.3. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis
Juan Wen, Jie Jiang, et.al.  Fertility and Sterility, June 2012 Volume 97, Issue 6, 1331–1337
http://www.fertstert.org/article/S0015-0282(12)00287-7/abstract?cc=y=

 

 

 

OBJECTIVES: To conduct a meta-analysis of studies assessing the effect of IVF and intracytoplasmic sperm injection (ICSI) on birth defects.
METHODS: We identified all studies published by September 2011 with data related to birth defects in children conceived by IVF and/or ICSI compared with spontaneously conceived children, or birth defects in the children conceived by IVF compared with those by ICSI. Risk ratios from individual studies were pooled with the fixed and random effect models.
RESULTS: Of 925 studies reviewed for eligibility, 802 were excluded after screening titles and abstracts, 67 were excluded for duplicated data, data unavailable, or inappropriate control group, 56 were included in the final analysis. Among the 56 studies, 46 studies had data on birth defects in children conceived by IVF and/or ICSI (124,468) compared with spontaneously conceived children. These studies provided a pooled risk estimation of 1.37 (95% confidence interval [CI]: 1.26–1.48), which is also evident in subgroup analysis. In addition, 24 studies had data on birth defects in children conceived by IVF (46,890) compared with those by ICSI (27,754), which provided an overall no risk difference.
CONCLUSIONS: Children conceived by IVF and/or ICSI are at significantly increased risk for birth defects, and there is no risk difference between children conceived by IVF and/or ICSI.
 
 

 

A multi-centre cohort study of the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception
M. Bonduelle, U.-B. Wennerholm, et. al.

Human Reproduction Volume 20, 2004, Issue 2, 413-419.


BACKGROUND: Over a million children have been born from assisted conception worldwide. Newer techniques being introduced appear less and less ‘natural’, such as intracytoplasmic sperm injection (ICSI), but there is little information on these children beyond the neonatal period. METHODS: 540 ICSI conceived 5-year-old children from five European countries were comprehensively assessed, along with 538 matched naturally conceived children and 437 children conceived with standard IVF. RESULTS: Of the 540 ICSI children examined, 63 (4.2%) had experienced a major congenital malformation. Compared with naturally conceived children, the odds of a major malformation were 2.77 (95% CI 1.41–5.46) for ICSI children and 1.80 (95% CI 0.85–3.81) for IVF children; these estimates were little affected by adjustment for socio-demographic factors. The higher rate observed in the ICSI group was due partially to an excess of malformations in the (boys') urogenital system. In addition, ICSI and IVF children were more likely than naturally conceived children to have had a significant childhood illness, to have had a surgical operation, to require medical therapy and to be admitted to hospital. A detailed physical examination revealed no further substantial differences between the groups, however.
CONCLUSIONS: Singleton ICSI and IVF 5-year-olds are more likely to need health care resources than naturally conceived children. Assessment of singleton ICSI and IVF children at 5 years of age was generally reassuring, however, we found that ICSI children presented with more major congenital malformations and both ICSI and IVF children were more likely to need health care resources than naturally conceived children. Ongoing monitoring of these children is therefore required.

 

 

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