Is there an Association between ASD and Assisted Reproductive Technology?

Background: Infertile couples have easier access and fewer constraints to have children using assisted reproductive technology (ART), which permits 1.2% of live births in the U.S. and California. We suspected an association between ART and autism (ASD) based on clinical experience.

Objectives: To determine the rate of ART in a clinical practice of children with ASD.

Methods: All new consultations for ASD (N=715) from 2002 through 2006 were reviewed to document: the use of/ type of ART; parental age/ education; and insurance provider.

Results:

• ART⁺ represented 10% of the total ASD sample, an 8-fold increase over the expected 1.2%. When only those with commercial insurance (CI) were included (thereby better controlling SES), the rate of ART increased to 14%, a 12-fold increase. 
• Forty-five percent of the ART⁺ children were singletons, and 42% were twins. 
• ART methods included: 21% ovarian stimulation medication alone; 30% in vitro fertilization ± intracytoplasmic sperm injection; and 38% a combination of methods.
• The male-to-female ratio in the ASD sample was 3.5-to-1, and in the ART⁺ sample was 2.7- to-1. 
• The parents of ART⁺ children were older (p<0.002) with more years of education (p<0.04) than the parents of non-ART ASD children.
• The ART⁺ children presented for evaluation 10 months younger than did the non-ART ASD children with CI (p<0.01).

Conclusions:

• This is the first known report of an apparent association between ART and ASD, with an 8-to-12-fold increase of ART⁺ in this clinical ASD sample over that expected in the general population.
• The variable ART methods suggests that in vitro manipulation is not the sole causative factor and warrants further research into association of infertility itself and parental age. 
• Couples undergoing ART procedures should be informed about the potential association with autism, and the offspring should be closely monitored.