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Fertility Challenges May Be Associated With Slight Differences in Child Behavior and Autism-like Symptoms, ECHO Study Finds
Authors: Linda Kahn, et al.
Who sponsored this study?
The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.
Why was this study needed?
More children are being conceived with the help of fertility treatments, and ECHO researchers wanted to assess whether these treatments or the fertility challenges that necessitate them might be linked to children’s behavior or autism-like symptoms. Fertility treatments include in vitro fertilization (IVF), where an egg is fertilized outside the body before being implanted in the uterus, as well as non-IVF treatments such as fertility medications or procedures like intrauterine insemination. Earlier studies investigating this association were often small, didn’t follow children for long, and couldn’t clearly distinguish the effects of treatment from the effects of infertility itself. They also did not consistently compare different types of fertility treatments. To address this gap, ECHO researchers used a large sample of study participants to compare children conceived with and without fertility treatment, including among families who experienced fertility challenges but conceived naturally, to better understand whether any differences in child behavior or autism-like symptoms are more likely related to treatment or to underlying fertility challenges.
What were the study results?
Trouble conceiving a pregnancy was associated with small differences in children’s behavior and autism-like symptoms. Children whose parents had fertility challenges had slightly higher behavior-problem scores, slightly more autism-like traits, and higher odds of an autism spectrum disorder (ASD) diagnosis, even when they were conceived without fertility treatment. The study also found that children conceived using non-IVF treatments had higher odds of ADHD compared with children conceived naturally (regardless of whether parents had reduced fertility). Researchers did not find clear evidence in this data that IVF itself was linked to brain development outcomes, and results did not meaningfully differ by the child’s sex or age group.
What was this study's impact?
These findings suggest that small increases in some behaviors such as aggression and rule-breaking or social communication problems in children conceived through fertility treatments may be related to the underlying fertility issues rather than the treatment itself. The possible link between non-IVF fertility treatments and ADHD needs more research, especially to understand whether the medical reasons for using these types of treatments rather than IVF explain the difference.
Who was involved?
The study included 15,382 mother-child pairs from 44 sites in the ECHO Cohort in the U.S. The analysis did not include adopted children or pregnancies using donor eggs or sperm. For twins or other multiples, the researchers included only one randomly selected child per pregnancy.
What happened during the study?
Researchers combined information from surveys and medical records to identify participants with a history of fertility challenges, including whether the parents had ever been told they had infertility, had infertility treatment, had two or more miscarriages, or had tried to conceive for 12 months without success. They also identified whether assisted conception involved IVF or non-IVF treatments (like fertility medications or intrauterine insemination). They then looked at the children’s development and diagnoses from ages 2–10, using parent-completed questionnaires and reports of clinician diagnoses of ASD and ADHD.
Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.
What happens next?
Future studies could help researchers better understand which specific fertility problems might be linked to outcomes like ADHD and help to identify the possible biological pathways behind these associations.
Where can I learn more?
Access the full journal article, titled “Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO,” in JAMA Network Open.
The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Published June 01, 2026