ARTs of course affect babies, because they produce babies. Recent advances in ART, however, have not taken much notice of babies. Many changes in technique have been introduced without any investigation of the effects on the final product.

If I am to be polemical for a moment (it doesn’t happen often), I am very disturbed that any physician manipulating gametes and embryos, with the worthy goal of helping infertile couples, could change any aspect of the procedure (a culture medium, for example) and not bother to find out if there was any effect on the babies that result. (We now know that culture media do affect perinatal outcomes, babies are smaller after the use of one culture medium compared to another). The only criterion of success in the past has been whether the pregnancy rate increased. That’s right, the pregnancy rate. Not even the live birth rate, and certainly not the live birth at term of a healthy single baby.

Well I think the times they are a-changin, and some countries have decided that unrestricted free-enterprise ART is not in the best interests of society, or infertile couples, or of their babies. There are a number of disparate societies where restrictions on embryo transfers have been introduced, including Sweden, Belgium, and most recently Turkey and Quebec.

In Quebec we have reduced the frequency of twins after IVF from 30% (which is where it still is in the USA and the rest of Canada) to under 5%, this happened immediately after the introduction of the new reimbursement and regulation strategy.

Annie Janvier and I have just published a review article, now available from the previously anonymous Acta Paediatrica. We review the data regarding neonatal consequences of ART, most particularly multiple delivery, but also other effects such a congenital anomalies, which are also increased after ART.

The overall Odds of having a congenital anomaly are about doubled after all types of in vitro techniques (see for example here). I think we need to ban all innovations in IVF and any ART that manipulates gametes or embryos, unless they are accompanied by an objective evaluation of  the results, meaning adequate outcomes research, evaluating congenital anomalies, neurodevelopmental progress and other health outcomes.