Are there risks in the long term outcome of children born following assisted reproduction technology?

Most studies of assisted reproduction technologies reported that congenital malformations and aberrations, childhood cancers, acquired medical conditions, chronic illness, physical growth, and cognitive and socioemotional development were within the expected range for naturally conceived pregnancies. However, few studies had included children beyond adolescence, and many unanswered questions remain about their long-term outcomes. To optimise outcome, the endpoint one aims to achieve should be BESST outcome [Birth Emphasising a Successful Singleton at Term]. A multiple preterm birth is the main factor that adversely affects the outcome of children conceived by assisted reproduction technologies

Risks in multiple births especially from twin twin transfusion syndrome

Multiple pregnancies have increased over time, and currently account for 10% of perinatal deaths. Compared to singleton births, the perinatal mortality rate is four times higher and the cerebral palsy rate is five times higher in twins. Monozygotic monochorionic twins are at the highest risk, due firstly to the cell division process leading to chromosomal or other anomalous lethal aberration in one fetus, and secondly to twin twin transfusion syndrome [TTTS] especially from its adverse consequences on the surviving fetus if there is fetal death of its co-twin. The incidence of TTTS is 20% in monozygotic monochorionic twins. Although perinatal mortality in TTTS has reduced from 80% to 40%, neonatal and paediatric morbidity remains high. Ultrasonographic studies showed cardiac dysfunction in 80% and brain lesions in over 50% of cases. Serious ischaemic and embolic complications can also occur in the gut, liver, kidneys and limbs. Cerebral palsy develops in 20% of TTTS survivors, especially if the co-twin dies in utero, with another 20% having minor neurodevelopmental disabilities. Data are emerging on the obstetric risks, survival and neurological outcome associated with interventions for treating TTTS. R and omised controlled trials to examine the benefits and risks of these strategies and a TTTS registry at a national or an international level are recommended to help improve management and audit perinatal and paediatric outcomes