I-18: Evaluating Pregnancy and Long-Term Outcomes of ART

When treating infertile couples by assisted reproductive technologies (ART), all aspects of their care in individual clinics should be evaluated frequently. Results should then be compared with other clinics offering similar treatment. Evaluation of possible adverse longterm outcomes can be achieved by pooling results from individual clinics in national, regional and international registers and other data systems. As large numbers of infertile women have been treated by ART, it is not surprising that diseases such as cancer and other chronic diseases will be reported in some of these women and in their children. Relatively few studies have systematically evaluated any possible risk of cancer of the female reproductive tract, breast cancer and other diseases among women treated by ART. In a Swedish study based on national IVF data linked to the Swedish Cancer Register, women treated by IVF had a slightly higher risk of cancer before being treated, especially a higher risk of ovarian cancer. The risk of cancer after IVF was slightly reduced, mainly due to a lower risk of breast and cervical cancer. In another similar Swedish study, cancer in children and young adults was slightly more common among those conceived by IVF. The risk of one rare type of cancer, histiocytosis, was found be higher after IVF. However, the overall incidence of cancer in this younger age group is much less than in their mothers so other studies are needed to determine whether these results are replicated. The increased risk of cerebral palsy and other neurological impairment after ART seems to be due to the higher risk of preterm birth and multiple births in these pregnancies. Some of these adverse outcomes can be avoided by reducing the incidence of multiple births. Evaluating whether ART causes any increased risk of other diseases requires further careful analysis of data from many sources, sometimes combining data from national health registers in several countries. Such studies are needed to ensure that the safety of new modes of treatment is adequately monitored.