Choi et al report on the use of medically assisted reproduction (which includes medical ovulation stimulation and intrauterine insemination as well as in vitro fertilization [IVF]/intracytoplasmic sperm injection[ICSI]) in Australia.1 Australia is unique in that is has a single healthcare registry system (allowing the tracking of infertility treatments and subsequent births), and infertility care is available without restriction. The investigators looked at the trends of infertility treatment and the proportion of births in the country attributable to infertility treatment from 2009 to 2017 (the last year for which data were available). The results are striking. In 2017, 6.7% of all births resulted from infertility treatment. Over time, fewer medical treatments (such as Clomid or follicle-stimulating hormone–like fertility drugs) were used and far more higher-tech treatments, such as IVF/ICSI, were used. For women aged more than 40 years, 56% of live births occurred after fertility treatment. There was a threefold increase in newer treatments, including frozen embryo transfer after IVF/ICSI. Interestingly, this type of intervention (frozen embryo transfer) has recently been linked to an increased risk of childhood cancers.2
The proportion of children now born from infertility treatments likely exceeds the 6.7% reported in this study, and the potential effects of newer treatments on children should be monitored closely. Although these interventions are a godsend for couples affected by infertility, especially severe male factor infertility, ongoing studies will be needed to assess the potential impact of these treatments on population health.