Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Padjadjaran/Dr. Hasan Sadikin General Hospital, Bandung, West Java, Indonesia.
Bandung Fertility Center, Limijati Mother and Child Hospital, Bandung, West Java, Indonesia.
J Neurodev Disord. 2023 Aug 22;15(1):26. doi: 10.1186/s11689-023-09490-0.
Subtle abnormalities in children's intelligence, motor skills, and psychology from various assisted reproductive treatments (ARTs) might be underdiagnosed. Understanding the prognosis of intelligence, motor skills, and psychology in children from ART would provide parents with reasonable expectations and enable them to plan relevant support to achieve the optimum potential in ART children.
We searched PubMed, EMBASE, Ovid, Google Scholar, and Scopus databases until April 13, 2021, to identify relevant studies. Thirty-four studies met the inclusion and exclusion criteria. The meta-analysis employed a standardized mean difference model. The outcome of this study is to compare intelligence quotient (IQ), motoric ability, and behavioral problems between all ARTs, in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI) to naturally conceived (NC) children. Subdomains of intelligence based on the Cattell, Horn, and Carroll Model (CHC Model) of cognitive architecture, including fluid reasoning, short-term and working memory, processing speed, visual-spatial ability, long-term memory retrieval, and crystalized intelligence (knowledge), were evaluated and summarized in details. Motor skill was stratified into two domains: gross motoric and fine motoric. Behavioral problem was categorized as externalizing and internalizing behavior.
Meta-analysis showed that verbal intelligence score in IVF toddlers is significantly lower than NC toddlers (p = 0.02); conversely, ICSI toddlers scored significantly higher verbal intelligence score compared to NC toddlers (p = 0.005). Toddlers born after ART had significantly lower non-verbal intelligence score (p = 0.047). IVF toddlers scored significantly lower fine motor score (p = 0.01) compared to naturally conceived toddlers. Based on parent's CBCL, NC toddlers had higher total (p = 0.01) and externalizing behavior (p = 0.001) scores compared to ART toddlers. Evaluation of full scale IQ and all domains of intelligence in preschool and primary school children revealed that no significant differences exist between ART and NC children. Based on preschool and primary school parents' CBCL, IVF children had significantly lower externalizing behavior score compared to NC children (p = 0.04). Meta-analyses of studies on young adolescents revealed that ART young adolescents scored higher academically than their NC counterparts, including on mathematics (p < 0.00001) and reading or language (p < 0.00001).
Despite differences in certain aspects, this finding suggests that ART is unlikely to cause negative impacts on children's neurodevelopment.
各种辅助生殖技术（ART）可能会导致儿童智力、运动技能和心理方面的细微异常，而这些异常可能未被充分诊断。了解 ART 儿童的智力、运动技能和心理预后，可以为家长提供合理的预期，并使他们能够规划相关的支持，以实现 ART 儿童的最佳潜力。
我们检索了 PubMed、EMBASE、Ovid、Google Scholar 和 Scopus 数据库，截至 2021 年 4 月 13 日，以确定相关研究。符合纳入和排除标准的 34 项研究。荟萃分析采用标准化均数差模型。本研究的结果是比较所有 ART、体外受精（IVF）、胞浆内单精子注射（ICSI）与自然受孕（NC）儿童的智商（IQ）、运动能力和行为问题。基于 Cattell、Horn 和 Carroll 认知结构模型（CHC 模型）的智力亚域，包括流体推理、短期和工作记忆、处理速度、视觉空间能力、长期记忆检索和晶体智力（知识），进行了评估和详细总结。运动技能分为两个领域：粗大运动和精细运动。行为问题分为外向和内向行为。
荟萃分析显示，IVF 幼儿的言语智力得分明显低于 NC 幼儿（p = 0.02）；相反，ICSI 幼儿的言语智力得分明显高于 NC 幼儿（p = 0.005）。ART 出生的幼儿的非言语智力得分明显较低（p = 0.047）。IVF 幼儿的精细运动得分明显较低（p = 0.01），与自然受孕的幼儿相比。基于父母的 CBCL，NC 幼儿的总分（p = 0.01）和外向行为（p = 0.001）得分明显高于 ART 幼儿。对学龄前和小学生的全智商和所有智力领域进行评估后发现，ART 儿童与 NC 儿童之间不存在显著差异。基于学龄前和小学生家长的 CBCL，IVF 儿童的外向行为得分明显低于 NC 儿童（p = 0.04）。对青少年的研究进行荟萃分析后发现，ART 青少年的学业成绩高于其 NC 同龄人，包括数学（p < 0.00001）和阅读或语言（p < 0.00001）。
尽管存在某些方面的差异，但这一发现表明，ART 不太可能对儿童的神经发育产生负面影响。
