In vitro fertilization and the cloacal/bladder exstrophy–epispadias complex: A continuing association

Abstract 

Objective

To expand on a previously published analysis of children fertilized in vitro (IVF) who demonstrate the cloacal/bladder exstrophy–epispadias complex (CBEEC).

Patients and methods

Data were collected on CBEEC patients who were fertilized in vitro and seen at The Brady Urological Institute of The Johns Hopkins Hospital (Brady/JHH) from 1997 to 2004. The numbers of live births and IVF births were acquired/estimated from the US Centers for Disease Control. Incidence rates for CBEEC were estimated using International Clearinghouse for Birth Defects Monitoring Systems data. A Pearson-type chi-squared analysis evaluated the association between IVF and CBEEC.

Results

An estimated 322,937 IVF births occurred in the US in 1997–2004. The rate of CBEEC was estimated at 6.2:100,000. A total of 150 CBEEC patients born in 1997–2004 were evaluated at Brady/JHH of whom eight were IVF. Under the hypothesis of no association between IVF and CBEEC, the expected incidence of IVF in CBEEC children ranged between 0.60% and 1.59%. The observed incidence of IVF in CBEEC children evaluated at Brady/JHH ranged between 4.2% and 6.7%. Comparison of the expected and observed incidence using a Pearson-type chi-squared test resulted in a bootstrapped P value of 0.0182.

Conclusion

The incidence of IVF in CBEEC children appears to be higher than what would be expected if there was no association between IVF and CBEEC.

Keywords: Exstrophy, Epispadias, Birth defect, IVF, In vitro fertilization