The study found that infertility is a modest risk factor for childhood ADHD

In a recent study published in human reproductionIn the study, researchers evaluated the risk of attention deficit hyperactivity disorder (ADHD) in the offspring of infertile mothers or those receiving infertility treatment compared to the offspring of mothers experiencing unassisted pregnancies.

Study: Attention deficit hyperactivity disorder in children born to infertile mothers: a population cohort study. Image Credit: ClareM / Shutterstock

Studies investigating long-term neurodevelopmental outcomes in the offspring of infertile mothers and/or receiving infertility treatment are limited. Previous studies have shown an increased risk of behavioral, cognitive, and emotional disabilities after exposure to infertility treatment. However, studies evaluating the relationship between infertility treatment and ADHD have shown inconsistent results, and the reasons for these associations are unclear.

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In this study, researchers investigated whether the risk of developing ADHD was higher among offspring born to infertile mothers and/or receiving infertility treatment compared to mothers who became pregnant without this help.

The study was conducted between 2006 and 2014 in the province of Ontario, Canada and included single and multiple live births in hospital at 24 weeks gestation by mothers aged 18–55 years at the time of delivery with an OHIP number. .

Data on infertility treatment, hospital births, maternal health, pregnancy measures, and outcomes in the offspring were obtained from the inpatient and outpatient datasets of the Institute for Clinical Evaluation Sciences (ICES). Data on pregnancy characteristics such as pregnancy type were obtained from the Best Outcome Scoring and Network (BORN) database and associated ancient Niday datasets.

The team excluded the offspring of surrogates from the analysis because of the gestational and biological complications of surrogacy. Pregnancies resulting in miscarriage or death of the offspring before the age of four or those with insufficient data records were also excluded.

The main exposure was setting a pregnancy as follows: (1) unassisted pregnancy group (for reference), (2) infertility without corresponding treatment, diagnosed within two years prior to conception (International Classification of Diseases, 9th revision (ICD-9) code 628 ); (3) Ovulation Induction (OI) / Intrauterine Insemination (IUI) and (4) in the laboratory Fertilization (IVF) / Intracytoplasmic sperm injection (ICSI).

The primary outcome was a diagnosis of ADHD in the offspring after the age of four years, described as two outpatient diagnoses (ICD-9 codes 312-14) by either a psychiatrist or pediatrician and/or one diagnosis during hospitalization (ICD-10). F90,91). The result is evaluated until June 2020.

The team calculated hazard ratios (HRs) after data adjustments for maternal age, rural residence, income, immigration status, parity, smoking habits, obesity, alcohol and/or drug use, and maternal medical history, including mental illness (eg ADHD), Chronic hypertension, non-gestational diabetes mellitus, and the gender of the child. In addition, stratified analyzes were performed by method of delivery (Caesarean or vaginal), infant’s sex, polymorphism (single or multiple), and timing of infant delivery (preterm or term).


The analysis included a total of 925488 infants from 663,144 women. Of these, 87% were born after an unassisted pregnancy, 10% were born after infertility without infertility treatment, 1% were born after infertile OI/IUI, and 1.5% were born after IVF/ICSI. Follow-up assessments were performed for children aged four to eight years (median six years).

ADHD was diagnosed in seven percent of children born via unassisted pregnancy, eight percent in children born to infertile mothers without infertility treatment, seven percent in children born after OI/IUI, and six percent in those born after IVF Microinjection. The incidence rates of ADHD (per 1,000 individuals-years) were 12, 12.8, 12.9, and 12.2 among the children of mothers belonging to the unassisted pregnancy group, infertility without infertility treatment group, OI/IUI group, and IVF/ICSI group, Straight .

Regarding the unassisted pregnancy group, the adjusted heart rates for ADHD diagnoses were 1.2, 1.1, and 1.1 between the infertile with no treatment for infertility and the OI/IUI and IVF/ICSI groups, respectively. In the stratified analyses, ADHD risk patterns were largely preserved, with the exception in the analyzes stratified by sex, where absolute rates of ADHD were lower for females, but heart rates were relatively higher than for males.

In a sensitivity analysis restricted to the infertility group, for infertility without the infertility treatment group, the adjusted heart rates were 0.9 and 0.9 for children born after OI/IUI and after IVF/ICSI, respectively. When adding a year of birth to the analysis, considering a diagnosis of ADHD at 2 years of age, or limiting the analysis to children with available maternal BMI (n = 293123), the results were similar to those of the main analysis.


Overall, the study results show that infertility, even without infertility treatment, can be modestly related to the risk of developing ADHD in a child. The risk is not increased by infertility treatment. However, more research needs to be done to explore the factors associated with maternal infertility that contribute to ADHD in the child.


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