February 22nd, 2010 
More than 30 years after the world greeted its first “test-tube” baby with a mixture of awe, elation and concern, researchers say they are finding only a few medical differences between these children and kids conceived in the traditional way.
More than 3 million children have been born worldwide as a result of what is called assisted reproductive technology, and injecting sperm into the egg outside the human body now accounts for about 4 percent of live births, researchers reported Sunday at the annual meeting of the American Association for the Advancement of Science.
The majority of assisted reproduction children are healthy and normal, according to researchers who have studied them. Some of these children do face an increased risk of birth defects, such as neural tube defects, and of low birth weight, which is associated with obesity, hypertension and Type 2 diabetes later in life, the researchers said.
Carmen Sapienza, a geneticist at Temple University School of Medicine in Philadelphia, noted that few of these test tube children are older than 30, so it’s not known if they will be obese or have hypertension or other health problems at age 50 or older.
Sapienza said researchers found differences in 5 percent to 10 percent of chromosomes between assisted reproduction children and other kids.
What’s not clear is whether these differences result in some way from assisted reproduction techniques or if they stem from other factors, perhaps ones that caused the couple’s infertility in the first place.
One factor in low birth weight may be that in many cases assisted fertility results in multiple births, which tend to be early and of lower weight.
Sapienza noted that women seeking assisted reproduction tend to be older than those who conceive naturally, but said that had been controlled for in the studies comparing the two groups of children.
Dolores J. Lamb of the Baylor College of Medicine in Houston urged more testing of males for the reason for infertility.
“There are correctable causes of male infertility and a couple can then have children the natural way,” she said. Also, infertility can be the first symptom of diseases such as testicular cancer, Lamb said.
As of 2008, the most recent data available, the United States reported that 361 clinics did 140,795 treatment cycles leading to the birth of 56,790 babies.
Related
- Embryo screening test is ’safe’
An embryo screening test called pre-implantation genetic diagnosis (PGD) is safe for the children of singleton pregnancies, Belgian researchers say.
They looked at 581 children born at one Belgian centre over 13 years who had been screened using the PGD technique.
They found that rates of birth defects and deaths were similar to those of children born using other IVF methods.
However, significantly more deaths just after or before the birth were seen in multiple pregnancies following PGD.
The findings come after concerns that the PGD screening technique, which involves removing some of the embryo’s cells at an early stage, could lead to problems.
But the researchers, writing in the journal Human Reproduction, found no significant difference in birth defect rates when compared to 2,889 children born using IVF but who did not undergo the screening.
In total, 2.13% of PGD children had birth defects compared with 3.38% of the other children.
The perinatal death rate – the period immediately before and after birth – was also similar at just over 1% for singleton children in both groups.
However, for multiple pregnancies there was a difference. In the PGD group it was 11.73%, whereas among the others it was 2.54%.
- Having a baby when you’re over 40?
Lee Robinson wasn’t all that excited about having a baby, It’s not that she didn’t want one, it’s just that she and her husband, Claude, were happy with their busy lives in Thomson, Georgia, where she’s a high school teacher and he’s a caterer.
Life rolled merrily along until one day, at age 44, Robinson discovered to her great shock that she was pregnant. When not one but two pregnancy tests confirmed the news, she plastered herself to the internet to figure out how risky this pregnancy was for her and her baby.
What she found online wasn’t comforting. A slew of statistics about the high risks of birth defects for the baby and pregnancy-related diseases for her scared the wits out of her.
“I’d be less than normal if I didn’t think this was pretty severe, life-threatening stuff,” Robinson says. “All kinds of things run through your mind.”
These days, more women are finding themselves in Robinson’s situation. The birth rate for women age 40-44 increased 4 percent in 2008 from 2007, according to the Centers for Disease Control and Prevention. Contrast that to the birth rate for women below age 40, which went down as much as 3 percent from 2007 to 2008.
“Whatever can go wrong goes wrong at an increased rate for a woman who is older starting pregnancy,” says Dr. Alan Fleischman, medical director for the March of Dimes.
So just how scary is it for a woman over 40 to have a baby? We asked physicians at the March of Dimes and the American College of Obstetrics and Gynecologists to set the numbers out for us.
Higher risk of miscarriage
- At age 20: 1 in 10 women
- At age 35: 1 in 5 women
- At age 40: 1 in 3 women
- At age 45: 1 in 2 women
Noncancerous tumors called fibroids and endometriosis, the abnormal growth of the lining of a woman’s uterus, can lead to a miscarriage.
Higher risk of any chromosomal disorder
- At age 20: 1 in 526 births
- At age 30: 1 in 385 births
- At age 40: 1 in 66 births
- At age 45: 1 in 21 births
Women are born with all the eggs they’ll ever have. As a woman ages, her eggs also age.
Higher risk of Down syndrome
- At age 25: 1 in 1,250 births
- At age 30: 1 in 1,000 births
- At age 35: 1 in 400 births
- At age 40: 1 in 100 births
- At age 45: 1 in 30 births
- At age 49: 1 in 10 births
As a woman ages, the risk of delivering a baby with Down syndrome increases. Down syndrome is a genetic disorder often caused by an error in cell division. There are multiple types of Down syndrome, and the exact cause is not known.
Higher risk of gestational diabetes
- At age 20: 22 in 1,000 women
- At age 25: 36 in 1,000 women
- At age 30: 51 in 1,000 women
- At age 35: 67 in 1,000 women
- At age 40: 84 in 1,000 women
Pregnancy stresses the body, requiring the pancreas to produce more insulin. In older women, having a baby can trigger diabetes during pregnancy.
Higher risk of preeclampsia
- At age 20: 38 in 1,000 women
- At age 25: 37 in 1,000 women
- At age 30: 36 in 1,000 women
- At age 35: 39 in 1,000 women
- At age 40: 48 in 1,000 women
“Women as they get into their 40s may also have some hypertension already,” Fleischman says. “And if they do, they have a higher risk of that being exacerbated during pregnancy.”
Advantages of being an older mom
Working women who have children later in life are often able to spend more time with their families because they’re in a better position to negotiate flexible schedules, according to research by Elizabeth Gregory, author of the book, “Ready: Why Women Are Embracing the New Later Motherhood,” and director of the Women’s Studies Program at the University of Houston.
“Women report that the clout they’ve established at work in the years before they have kids gives them a bargaining chip that they wouldn’t have had” at an earlier stage of their career, Gregory says.
Plus, women who wait to have children make more money and are better able to provide for their families, according to Gregory’s analysis of 2000 census data.
Gregory looked at women in their early 40s and found sizable salary differences based on when they’d had their children. She found that those who’d had babies in their mid-20s had salaries in the mid-$40,000 range, but those who waited to have babies until their mid- to late-30s had salaries that averaged in the $70,000 range.
The reason, she says, is simple. “Once kids arrive, it’s much harder for women to continue to climb the career ladder, so if they start having babies earlier, they tend to get stuck down on the ladder,” she says.
Last week, Robinson gave birth to a healthy boy named Price, and now she and her husband are thinking about having another child, even though she’s 44 years old.
“It’s really overwhelming to think I never thought I was going to be a mom,” Robinson says. “We’re both just absolutely in love with this little baby.”
- What Are The Benefits/drawbacks To Feeding Tube For Cystic Fibrosis Patient?
My husband has cf. diagnosed at birth and is 5ft 7 about 106 pounds. Doctors want a feeding tube in but he works 40 plus hours a week and plays with our children and doesn’t want one because he feels it will greatly limit his ability to carry on like he is now.
- Infertility treatments may raise preterm birth risk
Couples who conceive through certain types of infertility treatment may have a higher-than-normal likelihood of having a premature baby, a new study suggests.
Danish researchers found that among more than 20,000 women who gave birth at their hospital between 1989 and 2006, those who had conceived through in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) had a higher risk of preterm delivery.
Of the 730 babies born to women who underwent IVF or ICSI, nearly 8 percent were premature and 1.5 percent were very premature — born before the 32nd week of pregnancy. A normal pregnancy lasts 40 weeks.
In comparison, roughly 5 percent of babies born to fertile mothers were premature, and 0.6 percent were born very preterm, the researchers report in the journal Fertility and Sterility.
When the researchers accounted for factors like the mother’s age, weight and exposure to cigarette smoking, the IVF and ICSI procedures were still linked to a 53 percent greater risk of preterm delivery and a doubling in the odds of very premature birth.
Other forms of fertility treatment — namely, fertility drugs and insemination — were not related to the risk of preterm delivery.
Nor was the higher risk with IVF and ICSI explained by elevated rates of twin or higher-order births. The study included only singleton births.
Together, the researchers say, the findings suggest that something about the IVF and ICSI procedures themselves might raise the odds of preterm birth.
Both IVF and ICSI involve joining a woman’s egg and a man’s sperm in a lab dish, then — if fertilization is successful — transferring one or more embryos to the woman’s uterus. ICSI is typically used for male fertility problems, including a low sperm count or poor sperm quality. It involves isolating a single sperm and injecting it directly into the egg.
“The IVF/ICSI procedures include hormone stimulation and mechanical procedures. Both of these factors may influence the risk of preterm delivery,” lead researcher Dr. Kirsten Wisborg, of Aarhus University Hospital in Denmark, told Reuters Health in an email.
The fact that other forms of fertility treatment were not linked to preterm delivery suggests that infertility itself is not to blame, according to Wisborg. However, she pointed out, couples who undergo IVF or ICSI may have a different “reproductive pathology” than those who conceive via fertility drugs or insemination, as they frequently have been infertile for a longer period and have failed to conceive through those “low-tech” fertility treatments.
There may also be other factors, unmeasured in this study, that put women who undergo IVF or ICSI at greater risk of preterm delivery, Wisborg said.
Another possibility, Wisborg said, has to do with the “vanishing twin” phenomenon. Some of the singleton births to women who underwent IVF or ICSI may have begun as a twin pregnancy, with only one fetus surviving beyond the early stages. Research suggests that these surviving fetuses are at increased risk of preterm delivery and low birth weight.
The most important factor in reducing preterm birth risk with IVF or ICSI is to avoid higher-order pregnancies, according to Wisborg. But women can also lower the risk, she said, by not smoking and avoiding alcohol during pregnancy.
- Why Does A Person With Esophageal Cancer Have A Feeding Tube Inserted Into The Duodenum Instead Of The Stomach?
A patient has esophageal cancer and must have a feeding tube inserted. The nurse tells the patient that the tube will be inserted surgically into the duodenum. The wife asks why the tube will not be inserted into the stomach. What should the nurse say?
