PURPOSE: We assessed the risk of exstrophy-epispadias complex in children conceived by in vitro fertilization or intracytoplasmic sperm injection.
MATERIALS AND METHODS: Data from the German Network for Congenital Uro-REctal malformations were compared to nationwide data from the German In Vitro Fertilization Register and the German Federal Statistical Office. Odds ratios (95% CI) were determined to quantify associations using logistic regression.
RESULTS: A total of 123 patients with exstrophy-epispadias complex born in Germany between 1997 and 2011 were recruited through participating departments of pediatric urology and pediatric surgery throughout the country as well as the German self-help organizations Blasenekstrophie/Epispadie e.V. and Kloakenekstrophie. All German live births (10,069,986) between 1997 and 2010 comprised the controls. Overall, 12 subjects (10%) and 129,982 controls (1%) were conceived by in vitro fertilization or intracytoplasmic sperm injection. Conception by assisted reproductive technique was associated with a more than eightfold increased risk of exstrophy-epispadias complex compared to spontaneous conception (OR 8.3, 95% CI 4.6-15.0, p < 0.001). Separate analyses showed a significantly increased risk of exstrophy-epispadias complex in children conceived by in vitro fertilization (OR 14.0, 95% CI 6.5-30.0, p < 0.0001) or intracytoplasmic sperm injection (OR 5.3, 95% CI 2.2-12.9, p < 0.0001).
CONCLUSIONS: This study provides evidence that assisted reproductive techniques such as in vitro fertilization and intracytoplasmic sperm injection are associated with a markedly increased risk of having a child born with exstrophy-epispadias complex. However, it remains unclear whether this finding may be due to assisted reproduction per se and/or underlying infertility/subfertility etiology or parent characteristics.
Written by:
Zwink N, Jenetzky E, Hirsch K, Reifferscheid P, Schmiedeke E, Schmidt D, Reckin S, Obermayr F, Boemers TM, Stein R, Reutter H, Rösch WH, Brenner H, Ebert AK. Are you the author?
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
Reference: J Urol. 2013 Apr;189(4):1524-9.
doi: 10.1016/j.juro.2012.11.108
PubMed Abstract
PMID: 23201374
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