|Year : 2014 | Volume
| Issue : 2 | Page : 129-133
Comparative evaluation of growth parameters of IVF children of West Bengal
Sudipta Kar, Subrata Sarkar, Ananya Mukherjee
Department of Pedodontics and Preventive Dentistry, Guru Nanak Institute of Dental Science and Research, Panihati, West Bengal, India
|Date of Web Publication||19-May-2014|
21F, Charakdanga Road, Uttarpara, Hooghly 712 258, West Bengal
Source of Support: None, Conflict of Interest: None
Context: Fertility rates have started declining in West Bengal, India in the last few decades. In vitro fertilization (IVF) is one of the major treatment modalities available to infertile couple. Aims: This study was aimed to evaluate and compare the growth parameters of IVF and spontaneously conceived children. The objective of this study is to relate the physical status of IVF children with that of spontaneously conceived group. Settings and Design: In a cross-sectional case-control study, growth parameters of 3-14-year-old children were assessed. Subjects and Methods: Weight and height of 3-14-year-old children were assessed. Birth weight and length of each case and control group was also recorded. The case group consisted of term, singleton babies who were outcome of IVF in the studied area in 2009. The control group consisted of term, first child, singleton, and spontaneously conceived 3-14-year-old children who were also resident of the studied area. A sample of 150 IVF and 150 spontaneously conceived children were examined. Statistical Analysis Used: Chi-square and student's t-test were used for data analysis. Results: No statistically significant difference found in the studied (IVF children) and the control group (spontaneously conceived children). Conclusions: Growth retardation is more prevalent in babies born through IVF in the initial phase of life, but later on, IVF children are considered same as spontaneously conceived children.
Keywords: Growth, height, IVF, test tube baby, weight
|How to cite this article:|
Kar S, Sarkar S, Mukherjee A. Comparative evaluation of growth parameters of IVF children of West Bengal. Int J Health Allied Sci 2014;3:129-33
|How to cite this URL:|
Kar S, Sarkar S, Mukherjee A. Comparative evaluation of growth parameters of IVF children of West Bengal. Int J Health Allied Sci [serial online] 2014 [cited 2020 Jan 17];3:129-33. Available from: http://www.ijhas.in/text.asp?2014/3/2/129/132701
| Introduction|| |
The first test tube baby in the world, Louise Brown,  was born on 25 July 1978 after in vitro-fertilization (IVF) by R. G. Edwards and P. Steptoe in Oldham, (1978)  England. This laid the foundation of Assisted Reproductive Technologies (ART) and was a landmark in infertility treatment.
India was not far behind in the scientific and technological developments of test tube baby procedure. A few days after the delivery of the first test tube baby in UK, an Indian team from Kolkata led by (Late) Dr. Subhas Mukherjee,  an excellent cryobiologist, and (Late ) Dr. Saroj Bhattacharya,  a well-known gynecologist, announced the birth of "Durga",  following a test tube baby procedure, on 3 October 1978. Dr. Mukherjee's work was initially not accepted because of lack of adequate scientific documentation. However, subsequently (2003) his work was recognized as authentic by Indian Council of Medical Research (ICMR) and his team has been accredited for delivering the first test tube baby in India and the second one in the world. After that, Dr. T. C. Anand Kumar  first scientifically documented test tube baby in India on 6 August 1986 in Mumbai.
Olivennes et al., (2002)  found prematurity, low birth weight, and perinatal mortality were higher in children born after IVF than in the general population. Pinborg et al., (2003)  observed no major differences in physical health between IVF/intracytoplasmic sperm injection (ICSI) twins and non-IVF/ICSI twins. Koivurova et al., (2003)  compared the main developmental milestones in children born after IVF with spontaneously conceived matched controls. They hypothesized that IVF children reach developmental milestones later. They observed that the growth of IVF children was behind that of control children during the first 3 years of life, but their psychomotor development was similar.
The present study was carried out with an aim to correlate the physical status of IVF children with that of spontaneously conceived children of West Bengal. Our specific objective was to determine the growth pattern of IVF children of West Bengal.
| Subjects and methods|| |
This was a descriptive, analytic, cross-sectional study approved by the Guru Nanak Institute of Dental Science and Research Ethical Committee. Growth parameters (height and weight) of 3-14-year-old children were evaluated at one point of time from June 2009 to June 2011.
The children in both case and control groups based on the route of pregnancy were enrolled for the entire course of study. In the IVF children group, gestational age were 37 to 42 weeks, singleton babies who were outcome of IVF in Institute of Reproductive Medicine, West Bengal were chosen by a computer-generated random number list. The control group consisted of term, first child, singleton, and spontaneously conceived 3-14-year-old children whom were referred to Department of Paedodentics and Preventive Dentistry, Guru Nanak Institute of Dental Science and Research, West Bengal for the primary dental health cheek-up Case and control matched for year of birth, area of residence, parity, gestational age, maternal weight, maternal age, and socioeconomic status. Medical records of both groups were reviewed and variables such as sex, gestational age, birth weight and length, route of delivery, maternal age, and parity were recorded. Multiple pregnancies, severe asphyxia, children with major congenital malformations, chromosomal abnormalities, and genetic syndromes were excluded in the present study. Because IVF is a costly treatment modality, all the studied samples were from mid and high socioeconomic status. Nearly all the children attended private schools. The weights of all samples were taken with a children's weighing scale with sensitivity of 10 g. The weighing scale was calibrated at regular intervals. The standing crown heel height was measured using a stadiometer. To eliminate error due to interobserver variations, all measurements were made by a trained single examiner of research who was not informed about the birth status of the children. The study was conducted after informed consent was obtained from the concerned authorities and the guardians of the children. Total 868 parents of the studied samples were approached to participate in the present study (384 IVF parents and 484 parents of spontaneously conceived children). Out of the above total, 150 IVF and 150 normal spontaneously conceived children's guardian agreed to participate in the present study. The subjects without shoes and in light summer dress were asked to stand on a weighing machine. The weight was recorded in kilograms. It was important that child should stand in the middle of the weighing machine. The weighing scale should be corrected for any zero error before measurement. The children were taken to the vertical scale i.e. stadiometer, graduated in centimeter, for measuring height. They were asked to take off their shoes and stand with both feet together. The subjects were then positioned in such a manner that their heels, buttocks, scapulae, and occiput should be touching the vertical support of the stadiometer and head should be straight without any bending. Head was so positioned that the child looked directly forward with the Frankfurt plane (the line joining the floor of external auditory meatus to the inferior margin of orbit), and the biauricular plane should be horizontal. The horizontal headboard was then brought down and kept firmly over the vertex end to compress the hair and touch the maximum height of the scalp. The measurement of height was then recorded in centimeter. During history taking, birth weight and length of case and control group was also recorded.
| Results|| |
A total of 150 IVF children and 150 spontaneously conceived children were studied. Among 150 IVF children, 75 (50%) were male and 75 (50%) were female. Among spontaneously conceived children, 103 (68.7%) were male and 47 (31.3%) were female. Distribution of the sample based on age and sex are depicted in [Table 1] and [Figure 1]. Percentage distribution of height and weight of IVF children and naturally conceived children are described in [Table 2].
The mean birth weight of the IVF children was found to be 2.27 kg and the mean birth weight of the spontaneously conceived children was 2.96 kg, t value was 5.14, d.f = 298, P < 0.001 and the result was statistically significant. The mean birth length of IVF children was found to be 48.59 cm and the mean birth length of the spontaneously conceived children was 48.81 cm, t value was 1.63, d.f = 298, P > 0.05 and the result was statistically nonsignificant [Table 3], [Table 4], [Table 5].
|Figure 1: Sex wise distribution of IVF children and Spontaneously conceived children|
Click here to view
The mean height of the IVF children was found to be 125.25 cm (SD 25.275) and the mean height of the spontaneously conceived children was 130.25 cm (SD 22.23), t value was 0.51, d.f = 22, P > 0.05 and the result was statistically nonsignificant. The mean weight of the IVF children was found to be 30.02 kg (SD 30.08) and the mean height of the spontaneously conceived children was 12.75 (SD 16.68), t value was 0.009, d.f = 22, P > 0.05 and the result was statistically nonsignificant [Table 6] and [Table 7].
|Table 1: Sex wise distribution of IVF children and spontaneously conceived children|
Click here to view
|Table 2: percentage distribution of IVF and spontaneously conceived children in relation to present height and weight|
Click here to view
|Table 3: Distribution of IVF and spontaneously conceived children in relation to birth, weight and length |
Click here to view
|Table 4: Mean weight at birth in IVF and spontaneously conceived children |
Click here to view
|Table 5: Mean length at birth in IVF and spontaneously conceived children |
Click here to view
|Table 6: Statistical analysis of present height of IVF and spontaneously conceived children |
Click here to view
|Table 7: Statistical analysis of present weight of IVF and spontaneously conceived children |
Click here to view
The differences in averages of height and weight between the IVF and spontaneously conceived children are both statistically nonsignificant as found by student's t test.
| Discussion|| |
The child is not just a miniature adult but a dynamic organism undergoing constant physical changes. The new WHO Child Growth Standards reveal that children born anywhere in the world and given the optimum start in life have the potential to develop to within the same range of height and weight. Although there are individual differences among children, but within large populations, regionally and globally, the average growth is similar. Children from India, Brazil, and Norway reflect similar growth patterns when provided healthy growth conditions in early life. The new standards prove that differences in children's growth up to the age of 5 years are more influenced by nutrition, feeding practices, environment, and health care than genetics or ethnicity.
First study on physical status evaluation was done by De Monte Beillard (1759-1776).  First study of growth was published by Scamman in 1927.  After that, various studies were done by different national and international scientists.
In India, first study was conducted by Ghosh, Sen, and Chandrasekhar in 1944.  From their study, they came to the conclusion that physical status may vary from person to person, race to race, state to state, or country to country. This inspired the present study to determine the physical status of IVF children.
From the present study, it was found that both height and weight of IVF children were increasing steadily like spontaneously conceived children . When regression equation had been worked out between height and weight for both IVF and spontaneously conceived children, the regression equations expressed the linear relationship between height and weight of children in two groups (IVF and spontaneously conceived children). It denotes that the physical growth of IVF children were proportionate with that of normal children. This study supports the findings of Olivennes et al.,  and Wennerholm et al. 
In the present study, it was also observed that the studied IVF children had low birth weight than the spontaneously conceived children. And the findings were significant (P < 0.001). This finding supports the previous studies done by Olivennes et al.,  Bergh et al., Gissler et al., and Koivurova et al. Length at birth was also found to be lower in IVF children then spontaneously conceived children but the result was not statistically significant (P > 0.05). Ceelen et al. found low infancy growth velocity was significantly higher in IVF children and did not matched with the present study. Youich et al.,  Morin et al.,  Wennerholm et al.,  Pindborg et al.,  Bondulle ,  Saunders et al., and Knoester et al. also found no difference in IVF children when compared with spontaneously conceived ones. Present study also partially supported this finding as it indicated that the physical status of IVF children was little lagging than spontaneously conceived children of similar age-group.
The reason behind this may be that mothers who undergo IVF procedure take a combination of fertility drugs before and immediately after the procedure, which may have an effect on the growing embryos. The human manipulation of sperm and ovum, in vitro culture, cryopreservation, and embryo transfer may affect developmental outcomes. More study is required to find out the reason for this.
| Conclusion|| |
In our study, no statistically significant difference was observed between IVF and spontaneously conceived children. Growth assessment and a timely and regular follow-up is necessary for early detection of any growth disorders of IVF children. More studies are required to evaluate the relationship among sociodemographic status along with the growth and development of artificially conceived children. The present study tried to find out through the obtained data whether the IVF children were at par with the spontaneously conceived children in their physical aspects or not. This study is also significant from social perspective as it motivates the parents of IVF children in a positive manner. Thus, we derived from our study that the IVF group of children were no longer inferior to the spontaneously conceived group during physical status evaluation. There are scopes for longitudinal study with more parameters. Researchers may accumulate more information about IVF children. On the basis of that information, a specific milestone chart can be formulated to initiate further studies in this unique field.
| References|| |
|1.||Steptoe PC, Edwards RG. Birth after the reimplantation of a human embryo. Lancet 1978;2:366. |
|2.||Chakraborty BN. Test Tube Baby Procedures Miracles, Mysteries and Miseries. 1 st ed. Kolkata: The Standard Literature Company Pvt. Ltd; 2005. p. 1-3. |
|3.||Olivennes F, Fanchin R, Ledee N, Righini C, Kadoch IJ, Frydman R. Perinatal outcome and developmental studies on children born after IVF. Hum Reprod Update 2002;8:117 28. |
|4.||Pinborg A, Loft A, Schmidt L, Andersen AN. Morbidity in a Danish national cohort of 472 IVF/ICSI twins, 1132 non IVF/ICSI twins and 634 IVF/ICSI singletons: Health related and social implications for the children and their families. Hum Reprod 2003;18:1234 43.-3. |
|5.||Koivurova S, Hartikainen AL, Sovio U, Gissler M, Hemminki E, Jarvelin MR. Growth, psychomotor development and morbidity up to 3 years of age in children born after IVF. Hum Reprod 2003;18:2328-36. |
|6.||Mukherjee DK, Banerjee I. A short review of growth studies-national and international. In: Mukherjee DK, editor. Growth and Development. 1 st ed. New Delhi: Jaypee Brothers Medical Publishers Pvt Ltd; 2008. P. 1-6. |
|7.||Wennerholm UB, Albertsson-Wikland K, Bergh C, Hamberger L, Niklasson A, Nilsson L, et al. Postnatal growth and health in children born after cryopreservation as embryos. Lancet 1998;351:1085-90. |
|8.||Bergh T, Ericsson A, Hillensjo T, Nygren KG, Wennerholm UB. Deliveries and children born after in vitro fertilization in Sweden 1982-1995: A retrospective cohort study. Lancet 1999;354:1579-85. |
|9.||Gissler M, Malin Silverio M, Hemminki E. In vitro fertilization pregnancies and perinatal health in Finland 1991-1993. Hum Reprod 1995;10:1856-61. |
|10.||Ceelen M, van Weissenbruch MM, Prein J, Smit JJ, Vermeiden JP, Spreeuwenberg M, et al. Growth during infancy and early childhood in relation to blood pressure and body fat measures at age 8-18 years of IVF children and spontaneously conceived controls born to subfertile parents. Hum Reprod 2009;24:2788-95. |
|11.||Yovich JL, Parry TS, French NP, Grauaug AA. Developmental assessment of twenty in vitro fertilization (IVF) infants at their first birthday. J In vitro Fert Embryo Transf 1986;3:253-7. |
|12.||Morin NC, Wirth FH, Johnson DH, Frank LM, Presburg HJ, Van de Water VL, et al. Congenital malformations and psychosocial development in children conceived by in vitro fertilization. J Pediatr 1989;115:222-7. |
|13.||Bonduelle M, Wennerholm UB, Loft A, Tarlatzis BC, Peters C, Henriet S, et al. A multicentre cohort study on the physical health of 5-year-old children conceived after intracytoplasmic sperm injection, in vitro fertilization and natural conception. Hum Reprod 2005;20:413-9. |
|14.||Saunders K, Spensley J, Munro J, Halasz G. Growth and physical outcome of children conceived by in vitro fertilization. Pediatrics 1996;97:688-92. |
|15.||Knoester M, Helmerhorst FM, Vandenbroucke JP, van der Westerlaken LA, Walther FJ, Veen S, et al. Leiden Artificial Reproductive Techniques Follow-up Project (L-art-FUP). Perinatal outcome, health, growth, and medical care utilization of 5- to 8-year-old intracytoplasmic sperm injection singletons. Fertil Steril 2008;89:1133-46. |
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]