Sex-specific differences in head circumference of term singletons after assisted reproductive technology: a multicentre study in Japan

Research question: Does fertility treatment, specifically assisted reproductive technology (ART), affect head circumference in term singletons?Design: A total of 32,651 women who delivered at term at 12 maternity hospitals in Japan between 2010 and 2018 were included in the analysis; of these, 1941 (5.9%) and 2984 (9.1%) women conceived through ART and non-ART fertility treatments (timed intercourse, ovulation induction or artificial insemination), respectively. The study evaluated the adjusted odds ratios of head circumference >= 90th percentile stratified by infant sex and type of ART procedure after adjusting for covariates, with natural conception as the reference group.Results: ART significantly increased the risk of head circumference >= 90th percentile (adjusted odds ratio 1.56 [95% confidence interval 1.25-1.96]), whereas non-ART fertility treatment did not increase the risk (1.14 [0.92-1.42]). This increased risk of head circumference >= 90th percentile was observed exclusively in male neonates (1.73 [1.33-2.26]) and not in female neonates (1.18 [0.76-1.85]) in the ART group. Frozen embryo transfer (FET), FET in a hormone replacement cycle (HRC-FET) and blastocyst-stage embryo transfer were significantly associated with head circumference >= 90th percentile (1.60 [1.26-2.02], 1.70 [1.30-2.22] and 1.72 [1.33-2.24], respectively).Conclusions :The use of ART, particularly FET, HRC-FET or blastocyst-stage embryo transfer, was linked with a heightened risk of head circumference >= 90th percentile compared with non-ART fertility treatment or natural conception. The increased risk was observed only in male neonates.