ABSTRACT
It is well established that children born after in vitro fertilization (IVF]
have poorer outcomes than spontaneously conceived children, mainly
depending on the high rate of multiple births and associated prematuri-
t y 1 - 6 . Other potential risks include an increased rate of malformations after
assisted reproductive technology (ART). Lancaster's study from the 1980s
was the first to report a higher prevalence of neural tube defects and trans-
position of the great vessels among IVF children 7. Further studies were
mostly reassuring as regards congenital malformations in children born
after conventional IVF. However, comparisons were most often made with
the expected outcome in the general population rather than with defined
control groups. Controlled studies have been published more recently,
where comparisons have been made with matched controls. In recent years
large registry studies have also been published, comparing A R T children
with the general population before and after adjusting for parental con-
founders. Concerns have been raised that A R T might increase the malfor-
mation rate in offspring, particularly after intracytoplasmic sperm injection
(ICSI). The reason for these concerns is that the ICSI technique makes use
of sperm bypassing natural selection, and thereby makes it possible for
genetic material from otherwise incompetent spermatozoa to be transmit-
ted. The technique itself is invasive and may interact with delicate proce-
dures close to the meiotic spindle. It is also known that men with severe
oligozoospermia have an increased rate of chromosomal aberrations8'9.
Other potential risks, which also apply to IVF, include gonadotropin stim-
