Study Links Parental Subfecundity to Higher Risk of Behavioral Problems and Autism in Children
USA: Underlying subfecundity, rather than infertility treatment itself, may be associated with adverse neurodevelopmental outcomes in children, according to a large US cohort study published in JAMA Network Open.
Linda G. Kahn from New York University Grossman School of Medicine and colleagues found that children born to parents with subfecundity were more likely to experience behavioral problems and receive a diagnosis of autism spectrum disorder (ASD), even when conception occurred naturally. Additionally, non-IVF infertility treatment was associated with a higher likelihood of attention-deficit/hyperactivity disorder (ADHD) in offspring, whereas no such association was observed with IVF.
The use of infertility treatments has increased considerably over recent decades, raising questions about their long-term effects on child health. However, it has remained uncertain whether any observed neurodevelopmental risks are related to infertility treatment itself or to the underlying subfecundity that prompted treatment. To address this question, the investigators evaluated associations between subfecundity, infertility treatment, and childhood neurodevelopment.
For the study, researchers analyzed data from the National Institutes of Health Environmental Influences on Child Health Outcomes (ECHO) Cohort, including 15,382 mother-child pairs with infants conceived between 1998 and 2022. Children were assessed between 2 and 10 years of age. Subfecundity was defined using several criteria, including a history of infertility diagnosis or treatment, prolonged unsuccessful attempts to conceive, or recurrent miscarriages. Infertility treatment was categorized as IVF or non-IVF treatment.
Neurodevelopmental outcomes were measured using validated caregiver-reported tools, including assessments of externalizing and internalizing behavioral problems and autism-related social responsiveness. Caregivers also reported physician diagnoses of ASD and ADHD.
Among the participants, the average maternal age at delivery was 30.9 years, while ASD and ADHD had been diagnosed in 7.6% and 7.1% of children, respectively.
The study led to the following findings:
- Parental subfecundity was associated with higher externalizing behavioral problem scores in children.
- Children of parents with subfecundity also had higher autism-related symptom scores.
- These associations remained significant even among children conceived naturally, indicating that the underlying fertility challenges, rather than infertility treatment, may contribute to neurodevelopmental risk.
- Offspring of parents with subfecundity had significantly higher odds of being diagnosed with autism spectrum disorder.
- Children conceived through non-IVF infertility treatment had significantly higher odds of attention-deficit/hyperactivity disorder than those conceived naturally.
- IVF conception was not associated with an increased risk of ASD, ADHD, or behavioral problems.
The researchers noted that differences in access to infertility diagnosis and treatment, demographic variations between groups, and incomplete exposure data across cohorts may have influenced the findings.
They concluded that parental subfecundity was independently associated with behavioral problems and ASD in children, while non-IVF infertility treatment was linked to ADHD. They called for further studies to identify the underlying causes of these associations and clarify the biological mechanisms involved.
Reference:
Kahn LG, Hipwell AE, Stanford JB, et al. Subfecundity, Infertility Treatment, and Child Neurodevelopment. JAMA Netw Open. 2026;9(6):e2617324. doi:10.1001/jamanetworkopen.2026.17324
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