Summary: A large new study separated the biological effects of parental infertility from the medical procedures used to address it. Researchers analyzed data from 15,382 mother–child pairs collected across 44 U.S. study sites to understand how parental subfertility and different fertility treatments relate to children’s neurodevelopment.
The findings indicate that children born to parents with underlying fertility difficulties show small but measurable differences in learning and behavior. These include modestly higher scores for behavior problems and greater odds of an Autism Spectrum Disorder (ASD) diagnosis, even when those children were conceived naturally without medical intervention. Importantly, the study found no evidence that In Vitro Fertilization (IVF) itself is linked to adverse neurodevelopmental outcomes. Instead, the results point to parental biological, genetic, or environmental vulnerabilities associated with subfertility as the likely contributors to these subtle differences.
Key Facts
- Scope of the ECHO Cohort: This is one of the largest investigations of parental fertility and child neurodevelopment to date, drawing on 15,382 mother–child pairs from 44 sites across the United States, including Puerto Rico.
- Distinguishing subfertility from treatment: Earlier, smaller studies often could not separate the influence of fertility procedures from the conditions that prompted their use. The ECHO framework allowed researchers to disentangle those factors and examine their independent associations with child outcomes.
- Subfertility and child behavior: Children born to parents with chronic fertility challenges — such as a history of infertility diagnoses, multiple miscarriages, or prolonged time to conception — had slightly higher behavior-problem scores and more autism-like traits between ages 2 and 10, even when conceived without fertility treatment.
- Non-IVF treatments and ADHD: The analysis identified a statistical association between non‑IVF fertility treatments (for example, ovulation-stimulating medications or intrauterine insemination) and higher odds of an Attention-Deficit/Hyperactivity Disorder (ADHD) diagnosis compared with natural conception.
- IVF findings: The extensive dataset showed no clear links between IVF procedures and altered neurodevelopmental or behavioral outcomes, offering reassurance to families who use advanced reproductive technologies.
- Underlying drivers: According to study lead Linda Kahn, PhD, the associations likely reflect underlying parental factors — genetic, biological, or environmental — that cause subfertility and also influence child neurodevelopment, rather than the fertility treatments themselves.
Source: Duke University
Summary of findings
Neurodevelopmental differences in childhood, including behavioral concerns and conditions such as ASD and ADHD, can influence long-term health and learning. As fertility treatments become more common, it is important to understand whether changes in child development stem from the treatments themselves or from parents’ preexisting fertility issues. Many prior studies were limited by small sample sizes or by difficulty untangling these influences.
To address this gap, researchers used the NIH-funded ECHO Cohort to examine how parental fertility history and fertility treatments relate to child neurodevelopment. The study included 15,382 mother–child pairs from 44 U.S. sites and combined survey data with medical records to classify pregnancies by fertility history, including infertility diagnoses, multiple miscarriages, and prolonged time trying to conceive. Children’s development between ages 2 and 10 was assessed using caregiver-completed behavioral questionnaires and reported clinician diagnoses of ASD and ADHD.
Key results showed that parental subfertility was associated with slightly higher caregiver-reported scores for behavior problems and increased autism-like traits, and with higher odds of an ASD diagnosis. These associations persisted among children conceived naturally, indicating that underlying parental fertility challenges — not fertility procedures — were driving the observed differences. The study also reported an association between non‑IVF fertility treatments and elevated odds of ADHD, while finding no clear association between IVF and neurodevelopmental outcomes.
Main takeaways:
- Parental fertility challenges are linked to small differences in children’s behavioral and developmental outcomes.
- Non‑IVF fertility treatments were associated with higher odds of ADHD in this analysis.
- IVF did not show a clear association with adverse neurodevelopmental outcomes in this study.
“This study adds to growing evidence that infertility treatment itself is not independently associated with child neurodevelopment outcomes,” said Linda Kahn, PhD, of NYU Langone Health. “Rather, parental factors that led to difficulty conceiving — whether genetic, environmental, or medical — appear to underlie these small differences in childhood development.”
Key Questions Answered:
A: No. The large NIH-funded study found no clear evidence linking IVF procedures to negative neurodevelopmental or behavioral outcomes. In this analysis, IVF appeared neutral with respect to long-term child learning and behavioral measures.
A: The study points to the parents’ underlying fertility issues. Children born to parents who struggled to conceive showed slightly higher behavioral scores and autism-like traits even when conception occurred naturally, suggesting that biological, genetic, or environmental factors linked to subfertility are the likely drivers.
A: The data showed an association between non‑IVF fertility treatments and higher odds of a child being diagnosed with ADHD compared with children conceived naturally. Researchers note this may reflect the underlying reasons parents required those treatments rather than a direct harmful effect of the treatments themselves, and they recommend further research.
Editorial Notes:
- This article was edited by a Neuroscience News editor.
- The full journal paper was reviewed for this summary.
- Additional context was provided by the editorial staff.
About this neurodevelopment research news
Author: Josee Meehan
Source: Duke University
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 et al., published in JAMA Network Open. DOI: 10.1001/jamanetworkopen.2026.17324
Abstract
Associations of subfecundity and infertility treatment with child neurodevelopment in ECHO
Importance
As more children are conceived using infertility treatments, concerns persist about potential effects on child neurodevelopment. Large, contemporary studies are needed to clarify whether observed differences result from the treatments or from parental subfertility itself.
Objective
To evaluate whether infertility treatment is associated with child neurodevelopment and whether any such association can be attributed to underlying subfertility.
Design, Setting, and Participants
This cohort study used data from the NIH Environmental Influences on Child Health Outcomes (ECHO) Cohort, including children conceived between 1998 and 2022. The analysis included mother–child dyads and focused on neurodevelopmental outcomes assessed between ages 2 and 10. Data were analyzed from May 14, 2025, to March 31, 2026.
Exposure
Subfecundity was defined by prior consultation, treatment, or diagnosis of infertility for either partner; a history of two or more miscarriages; or trying to conceive for 12 months or longer without success. Infertility treatments were categorized as IVF or non‑IVF treatments.
Main Outcomes and Measures
Caregiver responses to standardized questionnaires produced continuous scores for externalizing and internalizing behavior problems. The Social Responsiveness Scale (SRS) measured autism-like symptoms. Caregivers also reported clinician diagnoses of ASD and ADHD.
Results
Among 15,382 mother–child pairs, subfecundity was associated with higher externalizing behavior scores and higher SRS scores overall and among naturally conceived children. Offspring of parents with subfecundity had higher odds of an ASD diagnosis. Children conceived with non‑IVF treatments had higher odds of ADHD compared with naturally conceived children, while no significant associations were observed for IVF treatment.
Conclusions and Relevance
In this large cohort, parental subfecundity was associated with modest increases in caregiver-reported behavioral symptoms and higher odds of ASD diagnosis, independent of fertility treatment. The association between non‑IVF treatments and ADHD warrants further study to determine whether specific indications for treatment contribute to risk. IVF was not clearly linked to child neurodevelopmental outcomes in this study.