Periodic Reporting for period 3 - MARTE (Medically Assisted Reproduction: The Effects on Children, Adults and Families)
Periodo di rendicontazione: 2022-02-01 al 2023-07-31
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?
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. 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. In a complementary analysis, we also show a negative association between MAR treatments and antidepressant purchases purchases only for women undergoing MAR treatments not resulting in a live birth, with no or negligible differences in AD utilization uptake between women conceiving through MAR and naturally. In contrast, women who remained childless after MAR treatments showed higher levels of AD purchases. The results highlight the heterogeneity in mental health amongst women with diverse reproductive experiences and the importance of counselling for women undergoing MAR treatments, especially if their attempts to conceive are unsuccessful.
We are currently working on a subsequent paper which explores the link between the mode of conception and loneliness and we show that the social loneliness of individuals who undergo MAR to conceive worsened in between two waves compared to individuals who are trying to conceive naturally. Compared to individuals who fail to conceive naturally, individuals who fail to conceive via MAR experience hardship increased in social loneliness whereas individuals who had a child in between two waves experience a slight improvement reduction in loneliness feeling regardless of the mode of conception.
The project has also produced important insights in so far as the socio-demographic selection into utilizing MAR to conceived. Parents who conceive through Assisted Reproductive Technology (ART) in Norway tend to be advantaged families. 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:
Overall, the evidence produced in the project so far shows that children conceived via MAR face higher risks of adverse birth outcomes (e.g. low birth weight) than children conceived naturally. The increased risks are attributed to a range of factors: the higher rates multiple births in the MAR group, the subfertility of couples who conceive via MAR and their demographic profiles as they tend to be older at the time of birth and more likely to give birth to their first child (both risk factors for adverse birth outcomes) than couples who conceive naturally. Our work suggests that the role of the MAR techniques on birth outcomes and neurological outcomes is likely to be negligible. The overall evidence on later life outcomes is reassuring. MAR children appear to have similar or better (physical, cognitive and educational) outcomes than children conceived naturally - even when the MAR children are born with adverse birth outcomes. A potential cause of concern is that some studies show increased risk of mental health problems amongst MAR conceived children. More systematic evidence is needed on the longer-term well-being of MAR conceived children.
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 the 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.
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. 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. In a complementary analysis, we also show a negative association between MAR treatments and antidepressant purchases purchases only for women undergoing MAR treatments not resulting in a live birth, with no or negligible differences in AD utilization uptake between women conceiving through MAR and naturally. In contrast, women who remained childless after MAR treatments showed higher levels of AD purchases. The results highlight the heterogeneity in mental health amongst women with diverse reproductive experiences and the importance of counselling for women undergoing MAR treatments, especially if their attempts to conceive are unsuccessful.
We are currently working on a subsequent paper which explores the link between the mode of conception and loneliness and we show that the social loneliness of individuals who undergo MAR to conceive worsened in between two waves compared to individuals who are trying to conceive naturally. Compared to individuals who fail to conceive naturally, individuals who fail to conceive via MAR experience hardship increased in social loneliness whereas individuals who had a child in between two waves experience a slight improvement reduction in loneliness feeling regardless of the mode of conception.
The project has also produced important insights in so far as the socio-demographic selection into utilizing MAR to conceived. Parents who conceive through Assisted Reproductive Technology (ART) in Norway tend to be advantaged families. 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:
Overall, the evidence produced in the project so far shows that children conceived via MAR face higher risks of adverse birth outcomes (e.g. low birth weight) than children conceived naturally. The increased risks are attributed to a range of factors: the higher rates multiple births in the MAR group, the subfertility of couples who conceive via MAR and their demographic profiles as they tend to be older at the time of birth and more likely to give birth to their first child (both risk factors for adverse birth outcomes) than couples who conceive naturally. Our work suggests that the role of the MAR techniques on birth outcomes and neurological outcomes is likely to be negligible. The overall evidence on later life outcomes is reassuring. MAR children appear to have similar or better (physical, cognitive and educational) outcomes than children conceived naturally - even when the MAR children are born with adverse birth outcomes. A potential cause of concern is that some studies show increased risk of mental health problems amongst MAR conceived children. More systematic evidence is needed on the longer-term well-being of MAR conceived children.
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 the 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). 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.