Fertility and Well-Being
At a Glance
Medically Assisted Reproduction
Kieron Barclay, Susie Lee, Mikko Myrskylä, Pekka Martikainen (MPIDR / University of Helsinki, Finland); in Collaboration with Alice Goisis (University College London, United Kingdom)
The use of medically assisted reproduction (MAR) — i.e., reproduction through treatments such as ovulation induction, intrauterine insemination, IVF, and ICSI — increased markedly over the last four decades. Previous research has consistently found that children born following medically assisted reproduction have worse perinatal outcomes than do children who were conceived naturally. However, the mechanisms underlying this association are not fully understood. Further, the association may be related to parental characteristics that predispose the parents to seek treatments in medically assisted reproduction and to be at high risk of adverse birth outcomes such as subfertility and advanced age, which are known risk factors for adverse birth outcomes.
In this project, we use high-quality data, innovative research designs, and advanced statistical methods to examine how MAR may affect health and psychosocial outcomes for children, their parents, and their families. We aim to develop an understanding of the causal effect of MAR on child outcomes and parental health by comparing the outcomes of children conceived through MAR to their spontaneously conceived siblings, and by comparing adults who successfully conceive through MAR to those who are unsuccessful. Our findings likely have important policy implications, potentially informing the decisions of couples, medical professionals, as well as public health authorities allocating resources towards MAR treatments.
Over the reporting period, we added new insights into the health implications of MAR treatments, building on findings gained from the earlier development of (our?) research on this topic. First, we strengthened the body of evidence on how MAR treatment itself affects children’s health, separately from other factors associated with the use of MAR (e.g., parental age, socioeconomic backgrounds). For example, results of our study based on data from Utah, United States, show that treatments in medically assisted reproduction are associated with adverse birth outcomes, but that these risks attenuate once neonatal and parental characteristics are adjusted via within-family comparison. This finding is in line with our earlier study (based?) on Finnish population register, again pointing at limited evidence on the effects of MAR on birth outcomes in a comparative sibling analysis. We also examined the maternal age gradient in the effect of MAR on birth outcomes, using Finnish registers, and found 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+). Second, we have expanded research to consider health consequences of MAR beyond perinatal birth outcomes, by considering adolescent health, and the health of parents themselves.
Fertility Development, Health Care, Public Health, Medicine, and Epidemiology
Goisis, A.; Palma Carvajal, M.; Metsä-Simola, N.; Klemetti, R.; Martikainen, P.; Myrskylä, M.; Pelikh, A.; Tosi, M.; Remes, H. M.:
SSRN research paper series 4109037. unpublished. (2022)
Pelikh, A.; Smith, K. R.; Myrskylä, M.; Goisis, A.:
Obstetrics & Gynecology 139:2, 211–222. (2022)
Remes, H. M.; Palma Carvajal, M.; Peltonen, R.; Martikainen, P.; Goisis, A.:
European Journal of Population 38:5, 915–949. (2022)
Goisis, A.; Myrskylä, M.:
Die Gynäkologie 54:12, 917–921. (2021)
Barbuscia, A.; Martikainen, P.; Myrskylä, M.; Remes, H. M.; Somigliana, E.; Klemetti, R.; Goisis, A.:
Human Reproduction 35:1, 212–220. (2020)
Barbuscia, A.; Myrskylä, M.; Goisis, A.:
SSM-Population Health 7:100355, 1–11. (2019)
Goisis, A.; Remes, H. M.; Martikainen, P.; Klemetti, R.; Myrskylä, M.:
The Lancet 393:10177, 1225–1232. (2019)