Editing Assisted reproductive technology (section)

== Risks ==
The majority of IVF-conceived infants do not have [[congenital disorder|birth defects]].<ref name="Van Voorhis 2007">{{cite journal |author=Van Voorhis BJ |year=2007 |title=Clinical practice. In vitro fertilization |journal=[[New England Journal of Medicine|N Engl J Med]] |volume=356 |issue=4 |pages=379–86 |pmid=17251534 |doi=10.1056/NEJMcp065743}}</ref>
However, some studies have suggested that assisted reproductive technology is associated with an increased risk of birth defects.<ref name="Kurinczuk 2004">{{cite journal |vauthors=Kurinczuk JJ, Hansen M, Bower C |year=2004 |title=The risk of birth defects in children born after assisted reproductive technologies |journal=Current Opinion in Obstetrics and Gynecology |volume=16 |issue=3 |pages=201–9 |pmid=15129049 |doi=10.1097/00001703-200406000-00002|s2cid=23159787 }}</ref><ref name="Hansen 2005">{{cite journal |vauthors=Hansen M, Bower C, Milne E, de Klerk N, Kurinczuk JJ |year=2005 |title=Assisted reproductive technologies and the risk of birth defects—a systematic review |journal=Hum Reprod |volume=20 |issue=2 |pages=328–38 |pmid=15567881 |doi=10.1093/humrep/deh593|doi-access=free }}</ref>
Artificial reproductive technology is becoming more available. Early studies suggest that there could be an increased risk for medical complications with both the mother and baby. Some of these include low birth weight, placental insufficiency, chromosomal disorders, preterm deliveries, gestational diabetes, and [[pre-eclampsia]] (Aiken and Brockelsby).<ref>{{Cite journal|doi=10.1017/S096553951600005X|title=Fetal and Maternal Consequences of Pregnancies Conceived Using Art|journal=Fetal and Maternal Medicine Review|volume=25|issue=3–4|pages=281–294|year=2016|last1=Aiken|first1=Catherine E. M.|last2=Brockelsby|first2=Jeremy C.}}</ref>

In the largest U.S. study, which used data from a statewide registry of birth defects,<ref name="Olson 2005">{{cite journal |vauthors=Olson CK, Keppler-Noreuil KM, Romitti PA, Budelier WT, Ryan G, Sparks AE, Van Voorhis BJ |year=2005 |title=In vitro fertilization is associated with an increase in major birth defects |journal=Fertil Steril |volume=84 |issue=5 |pages=1308–15 |pmid=16275219 |doi=10.1016/j.fertnstert.2005.03.086}}</ref>
6.2% of IVF-conceived children had major defects, as compared with 4.4% of naturally conceived children matched for [[maternal age effect|maternal age]] and other factors ([[odds ratio]], 1.3; 95% [[confidence interval]], 1.00 to 1.67).<ref name="Van Voorhis 2007" /> ART carries with it a risk for [[heterotopic pregnancy]] (simultaneous intrauterine and extrauterine pregnancy).<ref>{{Cite web|url=http://www.obgmanagement.com/the-latest/feature-articles/article/what-you-should-know-about-heterotopic-pregnancy/56cf1776e64a3aecc3e2b9f225cbc001.html?tx_ttnews%5BsViewPointer%5D=1|title=What you should know about heterotopic pregnancy : OBG Management|last=MD|first=Daniel M. Avery, MD, Marion D. Reed, MD, William L. Lenahan|website=www.obgmanagement.com|access-date=2016-07-28}}</ref>
The main risks are:
* [[Genetic disorder]]s
* [[Low birth weight]].<ref>{{Cite web|url=https://medlineplus.gov/ency/article/007279.htm|title=In vitro fertilization (IVF): MedlinePlus Medical Encyclopedia|website=medlineplus.gov|language=en|access-date=2018-11-07}}</ref> In IVF and ICSI, a risk factor is the decreased expression of proteins in [[energy metabolism]]; [[Ferritin light chain]] and [[ATP5A1]].<ref name=zhang>{{cite journal |vauthors=Zhang Y, Zhang YL, Feng C |title=Comparative proteomic analysis of human placenta derived from assisted reproductive technology |journal=Proteomics |volume= 8|issue= 20|pages= 4344–56|date=September 2008 |pmid=18792929 |doi=10.1002/pmic.200800294 |s2cid=206362532 |display-authors=etal}}</ref>
* [[Preterm birth]]. Low birth weight and preterm birth are strongly associated with many health problems, such as [[visual impairment]] and [[cerebral palsy]]. Children born after IVF are roughly twice as likely to have cerebral palsy.<ref>{{cite journal |journal=Arch Pediatr Adolesc Med |year=2009 |volume=163 |issue=1 |pages=72–83 |title=Cerebral palsy, autism spectrum disorders, and developmental delay in children born after assisted conception: a systematic review and meta-analysis |vauthors=Hvidtjørn D, Schieve L, Schendel D, Jacobsson B, Sværke C, Thorsen P |pmid=19124707 |doi=10.1001/archpediatrics.2008.507 |doi-access=free }}</ref>

[[Sperm donation]] is an exception, with a birth defect rate of almost a fifth compared to the general population. It may be explained by that sperm banks accept only people with high sperm count.

[[Germ cell]]s of the mouse normally have a frequency of spontaneous point [[mutation]]s that is 5 to 10-fold lower than that in [[somatic cell]]s from the same individual.<ref name="McCarrey2009">McCarrey JR. Maintenance of genetic integrity during natural and assisted reproduction. Reprod Biomed Online. 2009;18 Suppl 2:51-5. doi: 10.1016/s1472-6483(10)60449-x. PMID 19406032</ref>  This low frequency in the [[germline]] leads to [[embryo]]s that have a low frequency of point mutations in the next generation.  No significant differences were observed in the frequency or spectrum of mutations between naturally conceived fetuses and assisted-conception fetuses.<ref name = McCarrey2009/>  This suggests that with respect to the maintenance of genetic integrity assisted conception is safe.<ref name = McCarrey2009/>

Current data indicate little or no increased risk for [[postpartum depression]] among women who use ART.<ref>{{cite journal|doi=10.1093/humupd/dmq025|title=Risk for postpartum depression associated with assisted reproductive technologies and multiple births: A systematic review|year=2010|last1=Ross|first1=L. E.|last2=McQueen|first2=K.|last3=Vigod|first3=S.|last4=Dennis|first4=C.-L.|journal=Human Reproduction Update|volume=17|pages=96–106|pmid=20605900|issue=1|doi-access=free}}</ref>

Study results indicate that ART can affect both women and men's sexual health negatively.<ref>{{Cite journal |last1=Piva |first1=Isabella |last2=Lo Monte |first2=Giuseppe |last3=Graziano |first3=Angela |last4=Marci |first4=Roberto |date=August 2014 |title=A literature review on the relationship between infertility and sexual dysfunction: Does fun end with baby making? |url=http://www.tandfonline.com/doi/full/10.3109/13625187.2014.919379 |journal=The European Journal of Contraception & Reproductive Health Care |language=en |volume=19 |issue=4 |pages=231–237 |doi=10.3109/13625187.2014.919379 |pmid=24901746 |issn=1362-5187|url-access=subscription }}</ref>

Usage of assisted reproductive technology including [[Ovulation induction|ovarian stimulation]] and [[in vitro fertilization]] have been associated with an increased overall risk of [[childhood cancer]] in the offspring, which may be caused by the same original disease or condition that caused the infertility or subfertility in the mother or father.<ref>{{cite journal|pmid=23562045|doi=10.1016/j.fertnstert.2013.03.017|title=Fertility treatment and childhood cancer risk: A systematic meta-analysis|year=2013|last1=Hargreave|first1=Marie|last2=Jensen|first2=Allan|last3=Toender|first3=Anita|last4=Andersen|first4=Klaus Kaae|last5=Kjaer|first5=Susanne Krüger|journal=Fertility and Sterility|volume=100|pages=150–61|issue=1|doi-access=free}}</ref>

That said, In a landmark paper by Jacques Balayla et al. it was determined that infants born after ART have similar neurodevelopment than infants born after natural conception.<ref>Balayla, Jacques, Odile Sheehy, William D. Fraser, Jean R. Séguin, Jacquetta Trasler, Patricia Monnier, Andrea A. MacLeod, Marie-Noëlle Simard, Gina Muckle, and Anick Bérard. "Neurodevelopmental Outcomes After Assisted Reproductive Technologies." Obstetrics & Gynecology (2017).</ref>

ART may also pose risks to the mother. A large US database study compared pregnancy outcomes among 106,000 assisted conception pregnancies with 34 million natural conception pregnancies. It found that assisted conception pregnancies were associated with an increased risk of [[cardiovascular disease]]s, including [[acute kidney injury]] and [[arrhythmia]]. Assisted conception pregnancies were also associated with a higher risk of [[Caesarean section|caesarean delivery]] and [[Preterm birth|premature birth]].<ref>{{Cite journal |date=2022-09-20 |title=Assisted conception is linked to cardiovascular disease and birth complications |url=https://evidence.nihr.ac.uk/alert/assisted-conception-linked-to-cardiovascular-disease-birth-complications/ |journal=NIHR Evidence |language=en |doi=10.3310/nihrevidence_53388|s2cid=252416365 |url-access=subscription }}</ref><ref>{{Cite journal |last1=Wu |first1=Pensée |last2=Sharma |first2=Garima V. |last3=Mehta |first3=Laxmi S. |last4=Chew-Graham |first4=Carolyn A. |last5=Lundberg |first5=Gina P. |last6=Nerenberg |first6=Kara A. |last7=Graham |first7=Michelle M. |last8=Chappell |first8=Lucy C. |last9=Kadam |first9=Umesh T. |last10=Jordan |first10=Kelvin P. |last11=Mamas |first11=Mamas A. |date=2022-02-22 |title=In-Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology |journal=Journal of the American Heart Association |language=en |volume=11 |issue=5 |pages=e022658 |doi=10.1161/JAHA.121.022658 |issn=2047-9980 |pmc=9075081 |pmid=35191320}}</ref>

In theory, ART can solve almost all reproductive problems, except for severe pathology or the absence of a uterus (or womb), using specific gamete or embryo donation techniques. However, this does not mean that all women can be treated with assisted reproductive techniques, or that all women who are treated will achieve pregnancy.