P-779 School performance of children conceived by assisted reproductive technology
Authors: Spaan M , Ravelli A , Goddijn M , Lambalk C , Van Leeuwen F , Roseboom T 
Published: June 2023

Abstract

Study question
Does elementary school performance differ between children conceived through assisted reproductive technology (ART) compared to children born to subfertile couples not conceived by ART?

Summary answer
Children born after ART perform equally well at age 12 (end of elementary school) compared to children born to subfertile couples not conceived by ART.

What is known already
It is well established that pregnancies conceived by ART are at higher risk of adverse outcomes, such as pre-term birth and a lower birth weight, also when restricted to singleton pregnancies. However, whether ART also affects outcomes in later life, such as school performance, is less clear. Although some studies indicate that there might be subtle differences in the school performance of ART and spontaneously conceived children, it remains unclear whether this is due to the ART treatment, parental factors or a combination of both.

Study design, size, duration
Data were used from the OMEGA-cohort, a historical nationwide cohort with prospective follow-up in the Netherlands. The cohort comprises all offspring of women who were treated in one of the 13 IVF clinics or 2 regional fertility centers in 1983-2010. Of 89,249 live-born children, 54,417 were ART-conceived and 37,832 were not ART-conceived (conceived naturally with or without ovarian stimulation) by subfertile women.

Participants/materials, setting, methods
Data on type of fertility treatment and maternal risk factors were available from medical records of the mothers and through the national perinatal registry. The OMEGA-cohort was linked to the education dataset of Statistics Netherlands, including school performance data for the period 2006-2017, leaving 24,806 children in the analytical cohort. The overall test Z-score and Z-scores on the separate domains (Dutch language and mathematics) between ART and non-ART children were compared using multivariable linear regression.

Main results and the role of chance
The cohort comprises 14,958 ART-conceived children and 9,848 non-ART children with test scores around age 12 in 2006-2017. The mean overall score was 536,5 (SD = 9.7), with scores of 536.4 (SD = 9.9) in ART-conceived children and 536.6 (SD = 9.5) in non-ART children.
After adjustment for maternal age and maternal and paternal educational level, in a multivariable linear regression model, the overall test Z-score was also not different among ART-children compared to non-ART children from subfertile parents (β=-0.02, 95% CI=-0.04-0.01). Overall test Z-scores were not different according to different ART treatment modalities, IVF (β=-0.02, 95%CI=-0.05-0.01), ICSI (β=-0.01, 95% CI=-0.05-0.02) and frozen embryo transfer (β = 0.07, 95%CI=-0.01-0.14) when compared to children born to subfertile couples not using ART. ART children performed equally well on mathematics and Dutch language compared to children born to subfertile couples not conceived by ART.

Limitations, reasons for caution
Although the current analyses include a large proportion of the ART children in the Netherlands with data on school performance and our study had sufficient power to address the research question, it is not clear to which extent our results are generalizable to other countries.

Wider implications of the findings
Reassuringly, based on first results, children born after ART had comparable test scores at the end of elementary school compared to children from subfertile couples not conceived by ART.

Trial registration number
Not applicable