TY  - JOUR
A1  - Zwink, Nadine
A1  - Jenetzky, Ekkehart
A1  - Schmiedeke, Eberhard
A1  - Schmidt, Dominik
A1  - Märzheuser, Schmidt
A1  - Grasshoff-Derr, Sabine
A1  - Holland-Cunz, Stefan
A1  - Weih, Sandra
A1  - Hosie, Stuart
A1  - Reifferscheid, Peter
A1  - Ameis, Helen
A1  - Kujath, Christina
A1  - Rissmann, Anke
A1  - Obermayr, Florian
A1  - Schwarzer, Nicole
A1  - Bartels, Enrika
A1  - Reutter, Heiko
A1  - Brenner, Hermann
T1  - Assisted reproductive techniques and the risk of anorectal malformations: a German case-control study
JF  - Orphanet Journal of Rare Diseases
N2  - Background: The use of assisted reproductive techniques (ART) for treatment of infertility is increasing rapidly worldwide. However, various health effects have been reported including a higher risk of congenital malformations. Therefore, we assessed the risk of anorectal malformations (ARM) after in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
Methods: Data of the German Network for Congenital Uro-REctal malformations (CURE-Net) were compared to nationwide data of the German IVF register and the Federal Statistical Office (DESTATIS). Odds ratios (95% confidence intervals) were determined to quantify associations using multivariable logistic regression accounting for potential confounding or interaction by plurality of births. 
Results: In total, 295 ARM patients born between 1997 and 2011 in Germany, who were recruited through participating pediatric surgeries from all over Germany and the German self-help organisation SoMA, were included. Controls were all German live-births (n = 10,069,986) born between 1997 and 2010. Overall, 30 cases (10%) and 129,982 controls (1%) were born after IVF or ICSI, which translates to an odds ratio (95% confidence interval) of 8.7 (5.9-12.6) between ART and ARM in bivariate analyses. Separate analyses showed a significantly increased risk for ARM after IVF (OR, 10.9; 95% CI, 6.2-19.0; P < 0.0001) as well as after ICSI (OR, 7.5; 95% CI, 4.6-12.2; P < 0.0001). Furthermore, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed strong associations with ART (ORs 4.9, 11.9 and 7.9, respectively). After stratification for plurality of birth, the corresponding odds ratios (95% confidence intervals) were 7.7 (4.6-12.7) for singletons and 4.9 (2.4-10.1) for multiple births. Conclusions: There is a strongly increased risk for ARM among children born after ART. Elevations of risk were seen after both IVF and ICSI. Further, separate analyses of patients with isolated ARM, ARM with associated anomalies and those with a VATER/VACTERL association showed increased risks in each group. An increased risk of ARM was also seen among both singletons and multiple births.
KW  - metaanalysis
KW  - in-vitro fertilization
KW  - reproductive medicine
KW  - anal atresia
KW  - imperforate anus
KW  - anorectal malformation
KW  - birth defects
KW  - prevalence
KW  - assisted reproductive techniques
KW  - congenital malformations
KW  - descriptive epidemiology
KW  - infants born
KW  - children born
KW  - IVF-methods
KW  - technology
Y1  - 2012
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-134036
VL  - 7
IS  - 65
ER  -