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Medically Assisted Reproduction: The Effects on Children, Adults and Families

Periodic Reporting for period 1 - MARTE (Medically Assisted Reproduction: The Effects on Children, Adults and Families)

Reporting period: 2019-02-01 to 2020-07-31

The use of Medically Assisted Reproduction (MAR) – that is reproduction brought about through fertility treatments such as in vitro fertilization (IVF) – has increased steadily in advanced societies since the 1980s. To date, an estimated 8 million babies conceived through MAR have been born worldwide and more adults have undergone (successful or unsuccessful) MAR treatments. Given this trend, it is a public health and societal prerogative to find out whether MAR affects the well-being of families. Prior findings are mixed and often hampered by low statistical power or conceptual limitations.

The MARTE project proposes a program of research that goes beyond the state-of-the-art by being the first to analyze comprehensively the effects of MAR on children, adults, and families through a combination of uniquely rich data, previously unused research designs, and conceptual innovations. I propose three innovative projects which will address key unanswered questions. Project A focuses on adults, and will investigate: How are adults who underwent MAR treatments faring over the short and long term, and does this depend on whether the MAR treatments succeeded or failed? Project B focuses on children, and will investigate: Are children born after MAR more likely to have worse health outcomes but better social outcomes beyond childhood than children conceived spontaneously? Is the association causal? Project C focuses on parent-child relationships, and will investigate: How conflictual are parent-child relationships in MAR families when the children reach adolescence?
Project A:

We have examined changes in women’s mental health before, during, and after natural and MAR conceptions. The results show that the mental health of women who conceived naturally improved around the time of conception, and then gradually returned to baseline levels; whereas the mental health of women who conceived through MAR declined in the year before pregnancy, and then gradually recovered. The findings also indicate that women’s happiness decreased two years and one year before a MAR conception, and increased above the baseline in the year of pregnancy. We further show that the deterioration in mental health and subjective well-being before a MAR conception affects both partners, which could be part of a longer process in which the partners potentially suffer from stress related not just to the MAR treatments themselves, but to the experience of subfertility.

Parents who conceive through Assisted Reproductive Technology (ART) in Norway tend to be advantaged families, Parents conceiving through ART were more likely to be older, with the highest levels of income and education, and married. Moreover, their socio-demographic profiles did not change considerably during the period 1985-2014. Even though in Norway access to ART services is highly subsidized, the results highlight important and persisting social inequities in use of ART. The results also indicate that children born after ART grow up in resourceful environments, which will benefit their development and well-being.

Project B:

We have performed work looking at the birth outcomes of children born through MAR. Although, it is well established that MAR conceived children are at higher risk of poorer birth outcomes (e.g. low birth weight), the mechanisms underlying this associations and well as its consequences are still not well understood. We have already produced ground-breaking work which contributes to address these gaps in knowledge. First, we have shown that among MAR mothers, the risk of poorer birth outcomes does not increase with maternal age at birth except at very advanced maternal ages (40+). This is an important finding since the use of MAR is especially diffused among women who conceive at older ages. Second, we show that despite the high incidence of LBW among MAR children, they do not seem to experience any stunting in their cognitive development compared to naturally conceived children. This finding is largely explained by the fact that, on average, MAR children are born in socioeconomically advantaged families which compensate or more than compensate for their poorer birth outcomes.

We have examined several mental health and social outcomes in late adolescence (ages 16–18 in 2011–2017) of MAR conceived children and compared them to those of naturally conceived children. In baseline models (i.e. without adjustment for child/parental characteristics), the results show no major differences were observed in care episodes due to mental disorders and high-risk health behaviours whereas school drop-out, not being in education or employment, or early home-leaving were less common and school performance better among MAR-conceived adolescents. Adjustment for observed sociodemographic characteristics attenuated the differentials in social outcomes and revealed slightly higher risks of internalizing and developmental mental disorders among MAR adolescents. Internalizing mental health disorders were more common also when comparing MAR adolescents to their naturally conceived siblings, but this difference was attenuated in the adjusted model. For a variety of mental health and social outcomes, MAR adolescents showed similar or better outcomes than naturally conceived children, but specific mental disorders pose a cause of concern.

Project C:

Using data from the UK Millennium Cohort Study, we have shown that, on average, MAR and NC families have had similar parent-child relationships, as most family members’ reports showed no differences between MAR and NC families in parent-child closeness or quarrelling frequency. The only report in which we observe differences by conception mode is is the maternal maternal report on closeness with their children. Specifically, we find that as the MAR mothers reported higher closeness being closer with their children than the NC mothers, which is mediated by family characteristics and mental health. The results suggest that the difficulties and the stress parents underwent to conceive through MAR do did not translate into more difficult parent-child relationships during adolescence.
The rest of the project will focus on Projects A and B (since project C has been largely completed). We will build and expand on the results that we have already produced. The analyses of Project A will either reinforce the argument that MAR treatment negatively affects adults’ outcomes over the short and potentially longer-term; or instead show that the effects are short-lived or confounded by unobserved individual characteristics (e.g. individuals who suffer from infertility are more likely to suffer from mental health problems even before undergoing MAR treatments). The analyses of Project B will show whether the concern that MAR treatments have negative effects on children is justified by testing whether the association is causal and by looking at a range of health and social outcomes beyond childhood and over time. The project will have important policy implications, as its findings will be immediately relevant to health professionals advising couples seeking MAR treatments, to public health authorities allocating resources to mitigate the potentially negative effects of MAR on health, and to policy-makers considering whether to (further) subsidize MAR treatments.