Summary: A new study successfully separated the biological impact of parental infertility from the medical treatments used to resolve it. The epidemiological investigation analyzed an immense dataset of 15,382 mother–child pairs across 44 research locations.
The data reveals that children born to parents facing underlying fertility challenges experience small but measurable differences in learning and behavior, including slightly higher behavior-problem scores and elevated odds of an Autism Spectrum Disorder (ASD) diagnosis, even when conceived naturally without medical intervention. Strikingly, the data found zero evidence linking In Vitro Fertilization (IVF) itself to adverse neurodevelopmental traits, pointing instead to parental biological, environmental, or genetic subfertility as the primary driver.
Key Facts
- The Scale of the ECHO Cohort: The investigation stands as one of the most comprehensive parental-fertility and neurodevelopmental tracking initiatives ever conducted, incorporating 15,382 mother-child pairs drawn from 44 diverse U.S. study sites, including Puerto Rico.
- Isolating Infertility from Intervention: Historically, smaller studies struggled to determine whether childhood neurodevelopmental variations were caused by invasive fertility procedures or by the underlying medical conditions that made those procedures necessary. The ECHO framework successfully untangled these two variables.
- The Natural Subfertility Connection: Children of parents who experienced chronic fertility challenges (such as extended time trying to conceive, multiple miscarriages, or clinical infertility diagnoses) showed slightly elevated behavior-problem scores and more autism-like traits between ages 2 and 10, even when conceived without any fertility treatments.
- The Non-IVF Treatment Intersect: The analysis unmasked a specific statistical correlation between children conceived using non-IVF fertility treatments (such as ovulation-inducing medications or artificial insemination) and higher odds of an Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis compared to those conceived naturally.
- Vindication for IVF Protocols: Crucially, the extensive clinical data found no clear evidence associating IVF procedures with altered neurodevelopmental or behavioral outcomes, providing reassurance to millions of families utilizing advanced reproductive technologies.
- The Underlying Driving Forces: Dr. Linda Kahn of NYU Langone Health emphasized that infertility treatment is not independently linked to negative child development. Instead, the parents’ underlying biological, environmental, or genetic vulnerabilities, which caused the conception difficulties in the first place, are the true drivers behind these subtle childhood variations.
Source: Duke University
Difficulty conceiving a pregnancy may be associated with small differences in children’s learning and behavior, according to a new study funded by the Environmental influences on Child Health Outcomes (ECHO) Program at the National Institutes of Health (NIH).
Neurodevelopmental differences in childhood, including behavioral concerns and conditions such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), can affect long-term health and well-being.
As more families use fertility treatments, researchers are working to understand whether these treatments—or the underlying fertility challenges that preceded them—may be linked to children’s development. Previous studies have often been small or unable to separate the effects of infertility from the effects of treatment.
To address these gaps, researchers analyzed data from the ECHO Cohort, examining how fertility history and fertility treatments were related to children’s neurodevelopment. The study included 15,382 mother–child pairs from 44 study sites across the U.S., including Puerto Rico.
Researchers combined survey data and medical records to categorize pregnancies by fertility history, including infertility diagnoses, fertility treatments, multiple miscarriages, and extended time trying to conceive. Children’s development between ages 2 and 10 was assessed using parent-completed questionnaires and reports of clinician diagnoses of ASD and ADHD.
In this study, children of parents with fertility challenges showed slightly higher behavior-problem scores, slightly more autism-like traits, and higher odds of an ASD diagnosis, even when conceived without fertility treatment.
The study also found an association between children conceived using non–in vitro fertilization (IVF) fertility treatments had higher odds of ADHD compared with those conceived naturally. However, researchers did not find clear evidence that IVF itself was associated with neurodevelopmental outcomes.
Key takeaways include:
- Parental fertility challenges were associated with small differences in children’s behavioral and developmental outcomes.
- Conception using non-IVF fertility treatments was associated with higher odds of ADHD.
- IVF was not clearly associated with neurodevelopmental outcomes in this study.
“This study contributes to the growing body of evidence indicating that infertility treatment itself is not independently associated with child neurodevelopment outcomes,” said ECHO researcher Linda Kahn, PhD, of NYU Langone Health.
“Rather, it appears that the parents’ underlying fertility problems—whether stemming from genetic, environmental, or other influences—are likely driving these associations.”
Key Questions Answered:
A: No, quite the opposite. The massive NIH-funded study found no clear evidence linking IVF procedures to negative neurodevelopmental or behavioral outcomes. IVF itself appears to be entirely neutral regarding a child’s long-term learning and mental health tracking.
A: The parents’ underlying fertility issues. The research proved that children born to parents who struggled to conceive showed slightly higher behavioral issues and autism-like traits even when they were conceived naturally without any treatment. This indicates that the root biological, genetic, or environmental factors causing the parents’ infertility are what shape these minor childhood differences.
A: The data revealed a specific association between non-IVF fertility treatments and higher odds of a child developing ADHD compared to those conceived completely naturally. However, researchers suspect this link is also driven by the specific type of parental fertility challenges that require these medications, rather than the drugs causing damage themselves.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- Journal paper reviewed in full.
- Additional context added by our staff.
About this neurodevelopment research news
Author: Josee Meehan
Source: Duke
Contact: Josee Meehan – Duke
Image: The image is credited to Neuroscience News
Original Research: Open access.
“Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO” by Linda G. Kahn, Alison E. Hipwell, Joseph B. Stanford, Noya Galai, Haozuo Zhao, Akram N. Alshawabkeh, Judy L. Aschner, Emily S. Barrett, Ricardo P. Bertolla, Kim Nail Cajachagua Torres, Carlos A. Camargo Jr, Jose F. Cordero, Lisa A. Croen, Sean C. Deoni, Semsa Gogcu, Julie B. Herbstman, Margaret R. Karagas, Kaja Z. LeWinn, Kristen Lyall, Cynthia T. McEvoy, Kimberlee McKay, Thomas G. O’Connor, J. Richard Pilsner, Susan L. Schantz, Rebecca J. Schmidt, Alicia K. Smith, Greta N. Wilkening, E. Zhang, Yeyi Zhu, and Akhgar Ghassabian for the ECHO Cohort Consortium. JAMA Network Open
DOI:10.1001/jamanetworkopen.2026.17324
Abstract
Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO
Importance
Increasing numbers of children are conceived using infertility treatment; concerns remain about potential effects on child neurodevelopment.
Objective
To evaluate whether infertility treatment is associated with child neurodevelopment and whether such an association may be attributable to underlying subfecundity.
Design, Setting, and Participants
This cohort study was conducted among mother-child dyads in the National Institutes of Health Environmental Influences on Child Health Outcomes Cohort, with infants conceived between 1998 and 2022. Associations of subfecundity and infertility treatment with neurodevelopmental outcomes were assessed among children ages 2 to 10 years. Data were analyzed from May 14, 2025, to March 31, 2026.
Exposure
Subfecundity was defined as prior consultation for, treatment of, or diagnosis of infertility for either partner; at least 2 prior miscarriages; or ever having had unprotected heterosexual intercourse for 12 months without conceiving. Infertility treatment was categorized as in vitro fertilization (IVF) or non-IVF treatment.
Main Outcomes and Measures
Harmonized caregiver responses to the Strengths and Difficulties Questionnaire and the Child Behavior Checklist yielded continuous raw scores for externalizing and internalizing problems. The total raw Social Responsiveness Scale (SRS) score quantified autism-like symptoms. Caregivers reported physician diagnosis of autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD).
Results
Among 15 382 mother-infant dyads, there were 14 191 unique maternal participants (mean [SD] age at delivery, 30.9 [5.33] years; 8780 parous participants [57.1%]). ASD and ADHD were diagnosed in 876 offspring (7.6%) and 819 offspring (7.1%), respectively. In generalized linear models, subfecundity was associated with higher externalizing problem and SRS scores among all pregnancies (externalizing problems: b = 0.47 [95% CI, 0.14-0.81]; SRS score: b = 1.08 [95% CI, 0.01-2.14]) and when restricted to natural conceptions (externalizing problems: b = 0.45 [95% CI, 0.07-0.83]; SRS score: b = 1.12 [95% CI, −0.09 to 2.34]).
Offspring of parents with subfecundity had higher odds of ASD (overall: odds ratio [OR], 1.27 [95% CI, 1.03-1.57]; natural conceptions: OR, 1.31 [95% CI, 1.04-1.64]). Children conceived via non-IVF treatment had higher odds of ADHD compared with those conceived via natural conception with subfecundity (OR, 1.77 [95% CI, 1.16-2.68]) or without subfecundity (OR, 1.54 [95% CI, 1.05-2.25]). There were no significant associations for IVF treatment.
Conclusions and Relevance
In this large US cohort study, subfecundity was associated with elevated scores for caregiver-reported symptoms of behavioral problems and higher odds of ASD diagnosis, independent of infertility treatment. Non-IVF treatment was associated with ADHD, warranting further research into specific indications for treatment that may increase risk of offspring neurodevelopmental problems.
