Maryse Bonduelle Team

Follow-up of children born after assisted reproductive technology

Medical and psychological follow-up of PGD children

Principal Investigators: Julie Nekkebroeck

Researcher: Sandra Kuijfhout

Background:

Preimplantation genetic diagnosis (PGD) allows to determine specific monogenic defects, chromosomal imbalances and gender of the embryo. To perform PGD an embryo biopsy is needed, which removes one or two blastomeres and is performed at the 6- to 8-cell cleavage stage. PGD is a more invasive technique compared to ICSI and regular IVF and could induce potential risks for the children. PGD combined with HLA (Human Leukocyte Antigen) matching allows selecting of unaffected HLA compatible embryos in order to cure a severely affected sibling with a transplantation using haematopoietic stem cells from the newborn umbilical cord blood. This new application of PGD raises numerous medical, psychological and ethical questions. It is important to evaluate the health of the children born after PGD-HLA as well as the psychological well-being of these children and their family.

The Center for Medical Genetics of the UZ Brussel has a longstanding experience and expertise in the follow-up of children born after application of Assisted Reproductive Technology (ART). As the only centre in Flanders (Belgium) and one of the few centers worldwide and within the framework of an ongoing commitment to the long-term follow-up of children born after PGD, the research team from the Center for Medical Genetics assessed physical health in terms of growth and neuro-motor development of these children.

Aims

  • To assess whether PGD is associated with significant health, growth, mental and psychomotor outcomes in early childhood
  • To evaluate parental well-being and the parent-child relationship after PGD
  • To evaluate medical outcomes of PGD-HLA children
  • To evaluate psychological well-being of children born after PGD-HLA and their siblings and to describe the impact of this treatment on the family relations

Results

Medical outcome after PGD at 2 years

In the neonatal period, the outcome in terms of birth weight, low birth weight rate, prematurity rate, and major malformation rate is comparable between PGD and ICSI singletons.

At the age of 2 years, although overall anthropometrics were comparable between 102 children born after PGD and 102 children born after ICSI, body mass index standard deviation scores tended to be lower in children born after PGD in comparison to children born after ICSI.

Medical follow-up studies at the age of 5-6 years are planned for the near future.

Psychological outcome after PGD at 2 years

Seventy 2 year-old PGD/PGS singletons were examined and compared to the same number of ICSI and naturally conceived (NC) children. PGD/PGS singletons display normal mental and motor development when compared to ICSI and NC children. No differences for language development, temperament, and internalising problem behaviour were found.

PGD/PGS and ICSI mothers reported less total behaviour problems and externalising behaviour problems than the mothers in the NC group. ICSI fathers reported less total behaviour problems and externalising behaviour problems than the PGD/PGS and NC fathers. There were no differences between the parents on psychological well-being.

Results of the PGD/PGS twins were also very comparable with those of the ICSI and NC twins and this for all different domains of development.

Publications

Nekkebroeck J, Van den Broeck W, Desmyttere S, Ponjaert-Kristoffersen I, Bonduelle M. The mental, motor, socio-emotional and language development of 2-year-old twins born after PGD/PGS and parental well-being. Hum Reprod. 2012 Jan;27(1):299-301.

Desmyttere S, De Rycke M, Staessen C, Liebaers I, De Schrijver F, Verpoest W, Haentjens P, Bonduelle M. Neonatal follow-up of 995 consecutively born children after embryo biopsy for PGD. Hum Reprod. 2012 Jan;27(1):288-93.

Liebaers I, Desmyttere S, Verpoest W, De Rycke M, Staessen C, Sermon K, Devroey P, Haentjens P, Bonduelle M. Report on a consecutive series of 581 children born after blastomere biopsy for preimplantation genetic diagnosis. Human Reproduction 2010 Jan; 25(1);275-82.

Desmyttere S, Bonduelle M, Nekkebroeck J, Roelants M, LiebaersI , De Schepper J. Growth and health outcome of 102 2-year-old children conceived after preimplantation genetic diagnosis or screening. Early Human Development 2009; 85, 755759.

Desmyttere S, De Schepper J, Nekkebroeck J, De Vos A, De Rycke M, Staessen C, Liebaers I, Bonduelle M. Two-year auxological and medical outcome of singletons born after embryo biopsy applied in preimplantation genetic diagnosis or preimplantation genetic screening. Human Reproduction 2009 Feb;24(2):470-6.

Nekkebroeck J, Bonduelle M, Desmyttere S, Van den Broeck W, Ponjaert-Kristoffersen I. Mental and psychomotor development of 2-year-old children born after preimplantation genetic diagnosis/screening. Hum Reprod. 2008 Jul;23(7):1560-6.

Nekkebroeck J, Bonduelle M, Desmyttere S, Van den Broeck W, Ponjaert-Kristoffersen I. Socio-emotional and language development of 2-year-old children born after PGD/PGS, and parental well-being. Hum Reprod. 2008 Aug;23(8):1849-57.

PhD thesis

Parent-child relations and the development of young children born after Preimplantation Genetic Diagnosis (PGD) and Preimplantation Genetic Aneuploidy Screening (PGS). Julie Nekkebroeck (2008)

Promotor: I. Ponjaert. Copromotor: M. Bonduelle, C. Andries

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