Fertility and Well-Being

At a Glance Projects Publications Team


Medically Assisted Reproduction

Conducted by Mikko Myrskylä; Susie Lee, Pekka Martikainen (MPIDR / University of Helsinki, Finland); in Collaboration with Alice Goisis (University College London, United Kingdom)

Detailed Description

The use of medically assisted reproduction (MAR, i.e., reproduction through treatments such as ovulation induction, intrauterine insemination, and in vitro fertilization) increased markedly over the last four decades. Previous research has consistently found that children born following medically assisted reproduction have worse perinatal outcomes than children 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.

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 effects 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 conceived through MAR to those who are unsuccessful. Our findings likely have important policy implications, potentially informing the decisions of couples, medical professionals, and public health authorities allocating resources toward 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 have 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, have shown 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 have 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 look at the health consequences of MAR beyond perinatal birth outcomes by considering adolescent health and the health of parents themselves.

Research Keywords:

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.:
American Journal of Obstetrics and Gynecology 228:3, 311–312. (2023)    
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)
The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.