2023-07-08 10:41:01
What is the medium and long-term health of children conceived by in vitro fertilization (IVF)? Some 45 years following the birth of the first test tube baby, Louise Brown, on July 25, 1978, in England, and with over eight million people having been conceived this way worldwide, the question is still being asked. In France, 3,490 children were born in 2019 from IVF with immediate transfer, 7,292 from IntraCytoplasmic Sperm Injection (the injection of a sperm directly into an oocyte, ICSI) with immediate transfer, and 9,701 following transfer of a frozen embryo. On March 21, the French Academy of Medicine published a report on the subject.
One of its authors, Pierre Jouannet, a reproductive biologist and a Professor Emeritus at Paris-Descartes University, spoke to The world.
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What are the main recent developments in IVF in France?
I have seen three major developments over the last ten years. First, the average number of embryos transferred in utero per attempt has fallen. Initially, practitioners would transfer two or even three, which considerably increased the rate of multiple pregnancies and the associated problems concerning prematurity and the health of children and mothers. Today, it is recommended that only one embryo be transferred. Thanks to improved techniques, success rates have not fallen, and the rate of multiple births has been halved.
The second significant development is the transfer of the embryo into the uterus at the blastocyst stage [a structure of around 200 cells]which increases the chances of implantation. This involves the embryo developing for four or five days in the laboratory, which is not without consequences.
Lastly, improved freezing techniques, particularly vitrification, now used by all medically assisted reproduction centers, mean that embryos are of better quality. So much so that today, pregnancy rates obtained following transferring frozen embryos are as good as with “fresh” embryos. This improvement can modify the embryo transfer strategy. As hormone treatments given before oocyte collection are not always favorable for ensuring nesting in the uterine mucosa, it was realized that success rates might be better if all embryos were frozen immediately following IVF and then transferred at a later date. By 2020, this “freeze all” strategy had been adopted in over 20% of IVF and ICSI treatment cycles.
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What do we know regarding the health of children born from IVF?
There are over 1,500 publications in scientific journals on these children’s medium and long-term health. But we’re still far from knowing everything since the oldest are now in their forties for those born from IVF or in their thirties for those conceived by ICSI.
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