AUTISM: DOES IVF TREATMENT INCREASE THE INCIDENCE?
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At a recent meeting of the International Society for Autism Research (INSAR) on Thursday, May 20, 2010, a few papers were presented suggesting that in vitro fertilization is associated with an increased risk of autism in offspring. The world wide alarm that this evoked amongst infertile couples is understandable and is reminiscent of a similar “panic attack” that was sparked by a publication in the prestigious New England Journal of Medicine (NEJM) in the 90’s which suggested that the use of fertility drugs increased the risk of ovarian cancer. This ovarian cancer study was seriously flawed in that it:
a) was retrospective
b) failed to evaluate the effect of infertility itself on the incidence of ovarian cancer
c) did not adequately correct for the age of the women
d) failed to take into account family history
e) did not carefully consider the clinical cause of infertility and
f) did not account for the effect of ethnic/racial influences.
It was not until a decade or so later, following completion of several international studies in Australia, Europe, Israel and the United States that the findings of the original study were finally negated. However, by that time the message had unnecessarily traumatized an already vulnerable infertile community and created pandemonium amongst medical care givers.
The data reported at the INSAR meeting on IVF and Autism is interesting, but anecdotal. As with the original study reporting an increase in ovarian cancer in women taking fertility drugs, this study on IVF and Autism had potential shortcomings in that:
- It was also retrospective in design, thereby introducing recall and participation bias.
- The sample size was limited
- The reported incidence of autism in IVF babies versus the control group was also very small
- The incidence of autism is known to be more common in babies born to older mothers, and also in low birth weight offspring – both of which are collectively and individually much more common in IVF. Thus the perceived increase in the occurrence of autism in IVF babies was more likely to have been related to the “type of woman” who undergoes IVF rather than to the IVF treatment itself.
In the same vein, it would come as no surprise to wake up one morning to learn of a new study that attempts links IVF treatment and fertility drugs to an increase in the incidence of breast cancer. After all, breast cancer is more common in women in the 2nd half of their reproductive lives. The same is the case for many women undergoing IVF. Also, breast malignancy is more common in women who are overweight, but such women are also more likely to have hormonal dysfunction that causes infertility, often necessitating IVF [e.g. polycystic ovarian syndrome (PCOS)]. Then there is the reported finding that breast feeding somewhat protects against breast cancer… and of course, infertility precludes or delays the oportunity to breast feed.
It would be reasonable to assert that there are clinical, epidemiologic and demographic circumstances involving patients undergoing infertility and IVF treatments that are also associated with an increased incidence of breast and ovarian cancers. However, to then take it a step further and assert, based upon such associations, that a cause/effect relationship exists between infertility/IVF treatments and ovarian or breast cancer, would not be rational. Similarly, given present data, to claim that infertility and/or IVF treatment is causally linked to autism is somewhat analogous and very premature.
*Autism is a neurological, developmental disorder characterized by deficiencies in social interaction, verbal and nonverbal communication, and dysfunctional interests and behavioral patterns.
15 Responses to “AUTISM: DOES IVF TREATMENT INCREASE THE INCIDENCE?”
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I really enjoy reading your posts. Thank you for taking the time to write them. Informative, and very helpful!
You are most welcome! Thank you for your kind sentiments.
Geoff Sher
Thank you, its very helpful to have all this information in one place, unfortunately its hard to find such a collection of informative knowledge anywhere.
Thank you kindly.
Geoff Sher
Geez…that really puts me at risk then (said slightly sarcastically)…I had my first IVF baby at 40….luckily he shows NO sign of autism….but my 2nd baby will be at 43…however…I adopted an embryo which used the ovum of a 25 year old woman. Would the "older mother/autism" risk still apply?
Probably less of a problem if the adopted embryo came from a younger women.
Geoff Sher
Hello Dr. Sher. I have a question for you and I was unsure where to post it. I am an ovum donor and have donated twice through your clinic in Las Vegas.
I am interested in participating in the hcG "30 day diet" program to reset my metabolism. This will include taking daily injections of hcG and lipotropics. Will I still be able to donate while doing these injections?
Unfortunately, while you are on this regime you cannot donate.
Geoff Sher
Dr Sher,
I came to your blog to read about ovarian reserve and egg quality as I am AMA (40) and a poor responder (my recent cycle was a no transfer due to 8 abnormals confirmed by GSN testing) and happened upon this post….Well Done! I am an autism researcher at the MIND Institute and have been discouraged by the lack of criticism of this line of research!
Anyway, is there a place I can post my IVF history to get your input?
Thanks
Thank you Cynthia,
You might consider calling 800-780-7437 for a free medical telephone consultation with me to discuss your case.
Geoff Sher
Will do! Thanks
Copy!
Geoff Sher
Dr. Sher,
I spoke to your office and they suggested I call SIRM Sacramento (since I live near Sac). I was really hoping to get your input – can I write to you? I have detailed notes on my cycles.
Thanks,
Cynthia
Question – My wife and I are 43 and are thinking of having a donated egg. We have a 5 year old with autism. I understand the risks given from me that we already have an autistic child. My bigger question is with my wife. She has hypothyroidism and some other health issues that I believe may be the result of mercury poisoning as she said she actually played with mercury as a child. My son (non-fragile x, genetically normal) displays the symptoms to a "T" of heavy metals poisoning and tests through the roof on mercury. He does not have some of the symptoms you typically associate with autism (poor eye contact, no smiling, etc). He just stems a ton and has learning difficulties. I think he would be normal is not for the metsls.
My question is this: Even with a donated egg, do we run the risk of my wife passing the fetus mercury and raising the health risk? I ask this because I can't get a straight answer from internists or anyone because everyone wants to write off autism as a purely genetic disorder.
There is some risk, but it is very small. Discuss this with a specialist in Maternal and Fetal Medicine.
Geoff Sher