Children conceived through ICSI and IVF at 5 years of age: behavioral adjustment, parenting stress and attitudes: A comparative study.

Objective: Intracytoplasmic sperm injection (ICSI) is now an accepted
treatment for male infertility. ICSI bypasses the natural selection processes
of both traditional in vitro fertilization (IVF) and natural conception and
there are potentially more risks during fertilization. However, limited information
is available on the long-term outcome of children conceived
through ICSI. The objectives of this study were to examine 1) child
behavioral adjustment and, 2) parenting stress and attitudes in families who
conceived through ICSI compared to children conceived through traditional
IVF and natural conception.
Design: A prospective follow-up was conducted at 5 years of age for 99
children conceived through ICSI, 80 conceived through IVF and 113
non-IVF children conceived naturally.
Materials/Methods: At 5 years both parents completed questionnaires
concerning child behavior, temperament and development, and parenting
stress and attitudes (protectiveness, child vulnerability). Teachers also completed
measures of behavior and development. Statistical analyses were
conducted controlling for salient demographic and child variables (parent
age, education, language, child gender, twin).
Results: There were no significant between group differences in behavior
problem scores based on mother, father or teacher report, nor in parent
ratings of temperament. However, IVF mothers more often expressed concern
over child behaviors compared to ICSI and non-IVF mothers (p
.006). Non-IVF mothers rated their children’s development higher than
both ICSI and IVF mothers (p .033) and there was a trend in a similar
direction for teacher ratings of non-IVF children (p .067). There were no
significant group differences in mothers and fathers parenting stress scores.
While fathers reports of parenting attitudes did not differ between groups,
both ICSI and IVF mothers reported more protective attitudes (dependence,
control) compared to non-IVF mothers (p .010). Examination of the
relationship between parenting attitudes and behavior revealed that for the
whole sample more protective attitudes and perceptions of child vulnerability
by mothers and fathers were related to parent report of more difficult
child behavior/temperament.
Conclusions: This study showed that both ICSI and IVF mothers express
more protective parenting attitudes and IVF mothers express more concern
over child behavior compared to non-IVF mothers. However, there were no
group differences in parent or teacher reported child behavior adjustment
and mean ratings were in the non-clinical community range. Thus the
differences identified in ICSI and IVF maternal attitudes do not appear to
impact adversely on child adjustment. Indeed they may reflect a heightened
awareness of and sensitivity towards their child, related to the unique path
to conception.
Supported by: the Financial Markets Foundation for Children and North
Shore Fertility.