The most recent event from PET (the Progress Educational Trust) brought together researchers and clinicians to explore a key question about fertility treatment and its impacts. What does assisted reproduction mean for the short- and long-term health of the children born as a consequence?
The event was hosted by Sarah Norcross, director of PET, and produced in partnership with the Scottish Government. It build upon a previous event, which focused on the health of patients who undergo IVF and other forms of fertility treatment (see BioNews 1336).
In her opening address, Norcross highlighted the massive scale of fertility treatment, with more than 13 million IVF babies born since 1978. That figure is rising every day, with tens of thousands of cycles of fertility treatment delivered year on year in the UK alone.
The birth of Louise Brown, the world's first IVF baby, caused anxiety and speculation about possible abnormalities or long-term harm. However, Louise grew up healthy and had children of her own, without herself requiring fertility treatment. Today, even though short-term outcomes are well studied, the oldest cohorts of IVF-conceived adults are still in their 40s. This limits what may be concluded about any consequences for their health in later life.
The first speaker, Barbara Luke, is professor of obstetrics and gynaecology at Michigan State University. Her presentation explored whether health problems experienced by people born as a result of fertility treatment are driven by the treatment itself, or by the underlying fertility issues of the parents. She explained that such problems can reflect a combination of factors including genetics, parental health and the environment in which a pregnancy develops.
Evidence shows that birth outcomes are shaped by context. Professor Luke pointed to studies linking birthweight not only to the mother's health, but also to factors such as a grandmother's characteristics and even a grandfather's occupation, making birthweight an indirect measure of socioeconomic conditions such as previous generations' access to nutrition. Such findings illustrate that what happens before and during pregnancy cannot be straightforwardly separated from wider social and biological influences.
Looking specifically at assisted reproduction, certain procedures are associated with higher risks of complications. For example, transferring multiple embryos is linked to an increased likelihood of non-chromosomal birth defects. Intracytoplasmic sperm injection (ICSI) – originally used to address male infertility, but sometimes (wrongly) used more routinely – has been linked in some studies to lower semen quality, and reduced testosterone levels in male children later in life.
There is also evidence suggesting a small increase in birth defects among children conceived through IVF, and in these particular cases there is a potential association with higher risks of childhood cancer. Some data suggests that this risk may be slightly higher in IVF-conceived children, although the overall likelihood remains low. Professor Luke argued that these children should be monitored into adulthood, as certain risks may not manifest until later in life.
That said, Professor Luke also noted that many adverse outcomes are not unique to assisted reproduction. Children born prematurely tend to have poorer health and educational outcomes, regardless of how they were conceived. By contrast, IVF-conceived children who are born at full term often perform as well as, if not slightly better than, their peers in school.
Professor Alastair Sutcliffe, a professor of general paediatrics at University College London (UCL)'s Research Department of Population, Policy and Practice, offered a perspective that placed greater emphasis on subfertility (a term that he preferred to 'infertility'). Around one in seven couples have trouble conceiving, and these couples are likely to be older – and/or to have underlying health conditions or genetic factors – which could explain much of the increased risk to children born following assisted reproduction.
From this perspective, assisted reproduction per se is not the primary cause of adverse outcomes. While higher rates of preterm birth and neonatal admission are well documented, Professor Sutcliffe argued that these are more likely to reflect the parents' subfertility than to reflect the technology used. He also cautioned against overemphasising risks that are statistically small but can appear alarming when taken out of context. When it comes to risk of cancer in this context, for example, evidence remains inconclusive. Furthermore, provided that children are born at full term, multiple studies have found little evidence of significant differences in cognitive development, emotional wellbeing or educational performance compared with naturally-conceived children.
Professor Sutcliffe's colleague Dr Faiza Afzal, a senior research fellow at UCL, presented research examining how women undergoing fertility treatments perceive associated risks. Her work, based on a large qualitative survey, found that more than half of respondents reported no concerns about long-term outcomes for themselves or their children. However, among those who did express worries, concerns varied from future fertility and cancer risk to neurological development and educational attainment.
Dr Afzal highlighted the lack of information available to couples considering assisted reproduction. Many women reported that they had received little or no guidance from clinics about possible long-term outcomes. She argued that even where evidence is inconclusive, there is still a case for communicating it clearly to patients, thereby helping them to make informed decisions.
Next, the impact on the child's psychological health was explored by Vasanti Jadva, professor of family psychology at City St George's University. Her work has focused on the experiences of families formed through assisted reproduction and donor conception.
Professor Jadva debunked concerns that parents who had struggled to conceive might be overprotective, or might have overly unrealistic expectations of themselves and their child. Studies comparing families formed through IVF, donor conception, natural conception and adoption have consistently found that relationships between parents and children are at least as strong within families the first two categories as they are within families in the latter two categories (and in some cases stronger). Children conceived through assisted reproduction often report lower levels of conflict, and similar (or better) emotional wellbeing.
Furthermore, long-term studies following such children into adolescence and early adulthood have found no meaningful differences in rates of anxiety, depression or social difficulties. Educational outcomes are likewise similar to what would be expected.
Professor Jadva also discussed donor conception, specifically examining the concerns that a non-genetic parent might struggle to bond with a child, or that secrecy surrounding the child's genetic origin might create tension. She said that the former concern has not been borne out by research, but that openness does matter. People who learn about their origins at a younger age tend to report better family relationships and lower levels of distress, and there is some evidence that parents too experience lower anxiety levels in the context of such openness.
Professor Jadva shared a comment from an adult born through gestational surrogacy. 'It doesn't faze me really. People are born in all different ways, and if I was born a little bit differently that's okay – I understand.'
Following the presentations, a discussion with contributions from the audience focused on clarifying areas of uncertainty and practical implications for patients. Professor Luke addressed concerns about the use of ICSI, explaining that because the technique bypasses natural sperm selection and involves mechanical intervention, this may have some adverse outcomes.
Questions about ageing and long-term health highlighted the lack of data beyond midlife, though emerging genomic research suggests that early-life environmental stressors may influence ageing trajectories. Panellists agreed that studying older IVF-conceived individuals will be important to understanding the long-term impacts of assisted reproduction.
Overall, the discussion offered a largely reassuring message. While some risks and uncertainties remain, evidence to date shows that most children conceived through assisted reproduction are healthy, develop normally, and lead lives comparable to those of their peers.
PET is grateful to the Scottish Government for supporting this event.
Register for these upcoming PET events:
- Accessing Fertility Treatment: Challenges and Solutions for LGBTQ+ Communities, taking place online next month on Wednesday 10 June 2026 – register here.
- Donor Conception and Genetic Disease: Lessons to Be Learned from Donor 7069, taking place online next month on Wednesday 24 June 2026 – register here.