Cognitive and Speech Development of Preschool Children, Conceived through Assisted Reproductive Technologies

Introduction

The infertility of men and women is an important modern medical and demographic problem. One of the ways to solve the problem is the use of assisted reproductive technologies (ART), among which in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) are the most sought after. ART methods also include surrogacy, oocyte/sperm/embryo donation, preimplantation genetic testing, etc., all of which allow the family to utilize higher quality genetic material for a successful conception [3; 4; 5; 6; 7].

It may seem that favorable conditions have been created in which the percentage of healthy births in induced pregnancies will be significantly higher than in natural conception. But the presented studies in the field of studying the psychomotor development of a child from an induced pregnancy are very few and contradictory. Some authors claim that there are no significant differences in the development of children conceived with the help of ART and naturally conceived (NC) children [9; 10; 12; 15]. Other studies provide data on a higher incidence of developmental disorders among artificially inseminated children [1; 2; 11; 13; 14], which raises many questions about the possible impact of new technologies in human reproduction on further child development.

The presented study analyzes the obtained developmental history and data on the results of a neuropsychological and speech therapy examination of children conceived by ART, compared to children conceived in natural conditions. An integrated approach to the study of a child’s cognitive and speech development will make it more likely to identify variants of dysontogenesis at an early stage and to begin timely correctional work. The analysis of the applied methods of ART, the number of performed embryo transfers before pregnancy, the anamnestic data on child development allows us to consider the influence of these factors on the further psychospeech development of children. The cognitive and speech development of children aged 3 to 8 years old conceived by means of ART was analyzed.

Materials and Methods

Participants. The study included 115 children aged 3 to 8 years old, 54 of whom were conceived by ART and were the experimental group, and 61 children were the control group of children conceived naturally.

Research Methods. In the diagnostic examination of children’s cognitive and speech development, we used the methods of neuropsychological examination proposed by L.S. Tsvetkova [8] and standardized speech therapy diagnostics, including the assessment of the state of the mimic and articulatory muscles, breathing, vocalization, the features of sound pronunciation, syllabic structure, and the state of the general lexicogrammar structure of speech.

In accordance with the diagnostic methods used and for a more effective differentiated assessment of cognitive development, it was decided to divide the children involved in the study into two age groups: children aged 3 years to 4 years 11 months old and children aged 5 years to 7 years 11 months old. The two experimental groups (EG 1 and EG 2) included 54 children conceived through ART. The two control groups (CG 1 and CG 2) included 61 children conceived in naturally and with no history of clinical disease. The two groups were composed of children aged 3 to 5 years old: 25 children (15 boys, 10 girls) were included in EG 1; 25 children (16 boys, and 9 girls) were included in CG 1. Children aged 5 to 8 years old were also divided into two groups: EG 2 had 29 children (16 boys, 13 girls) and CG 2 included 36 children (18 boys, 18 girls). This division into age groups was dictated by the features of the neuropsychological examination for each age period. In the group of the younger and middle preschool age of children, adapted neuropsychological tests were used to assess intellectual activity, selected with regard to the age and individual abilities of the child.

Results and Discussion

In accordance with the purpose of the work, the data of the child’s medical history, protocols for the management of the ART procedure and the comprehensive diagnostics of psychospeech development were studied.

Detailed information about the applied methods of ART is given in Table 1. In the studied sample of 54 children conceived by ART: 28 children (53%) were conceived by the IVF procedure; 26 children (47%) were conceived by the ICSI procedure.

According to the medical records of the examined children conceived by ART, conditionally normal ontogenetic development was determined in 41% of cases in children from 3 to 8 years old. In 37% of the total number of children in the group, there were confirmed mental disorders, in 22% of cases there were neurological and genetic disorders.

According to the medical history, the examined children from the experimental groups had both normotypic development and different variants of deviant development. The data is presented in Table 2.

Intellectual disability was observed out of the whole sample of children aged 3—8 years old in 15% of cases. Autism spectrum disorders (ASD), as well as ADHD, were identified in 10% of children conceived by ART. Epilepsy was diagnosed in one child (2%).

In the comparison group: CG 1 and CG 2, no clinical illnesses were identified when analyzing medical history data, and dysontogenetic developmental variants had not been diagnosed previously. All children in the control groups had mental and speech development within the age norm.

Table 1

Distribution of Performed ART Procedures Among the Children of the Experimental Groups

Note: n=54 respondents, corresponding to 100% of the sample.

Mental Disorders in Children Conceived by Means of ART (n=54)

Assessment of the Cognitive Development of Children Participating in the Study Using Neuropsychological Research Methods

Table 3

Neuropsychological examination in the EG 2 group and in the CG 2 comparative group gave the following results: in the EG 2 group, the majority of children had a severe dissociation of the formation of a number of mental processes (voluntary attention, thinking, memory, perception, motor sphere), as compared to children from CG 2, who did not have any dissociation in cognitive development, and the insufficient formation of some mental functions was mainly functional in nature. The symptoms of underdevelopment of subcortical structures (diencephalic and stem structures), as well as of certain cortical structures, were observed in 35% of children from EG 2 and 23% of children from CG 2. Decreases in general neurodynamics were observed with approximately equal frequency in the two groups. In 15 % of children from EG 2 there were symptoms of the functional deficiency of the regulatory factor, which manifested themselves in the lack of assiduity, difficulties in retaining a given program, in a decrease in the motivational component of activity (rapid saturation of activity), in difficulties in concentrating on the task. In CG 2, 9% of children showed symptoms of the insufficient development of the regulatory factor, and the manifestations were functional and less pronounced than in the EG 2 group.

The development of thinking operations in EG 2 children, as compared to CG 2, was characterized by unevenness. In children with mental and speech developmental delays, the tasks of classification by a common characteristic, the method of Excluding objects (“4th is the odd one out”, “nonsense” exercises were available only when performed jointly with an adult, whereas in children with normal mental development, the success of the task completion depended on the conditions of domestic pedagogical training and the zone of actual development.

The speech therapy examination revealed different types of speech disorders (see Table 4).

Table 4 shows the percentage of speech disorders for each group of children in the study. Conditionally normal speech development was found in 39% of children (n=61) from the control group and in 22% of children (n=54) from the experimental group. Speech disorders of the dysarthria and alalia type were more common among children conceived by ART (78% of cases) and varied in severity: from a complete absence of speech to unexpressed, erased manifestations, as well as combined with general underdevelopment of speech from level 1 to 3. In the control groups, speech disorders were observed in 61% of children and manifested themselves in the form of minimal disorders of muscle tone in the organs of mimic muscles and articulation, the insufficiency of speech breathing and the prosodic design of speech, and the insufficiency of the phonetic and phonemic perception. General underdevelopment of speech in groups CG 1 and CG 2 was diagnosed less frequently and was within the 3rd level of development. Dyslalia was diagnosed in almost all groups of children with approximately the same percentage of occurrence.

According to the results of the study, it can be concluded that children conceived through assisted reproductive technologies represent a heterogeneous group in terms of cognitive and speech development parameters. According to the data of the study, the children from the experimental groups have a tendency towards a decrease in general neurodynamics, an insufficient regulation of emotions and behavior, and speech disorders of varying degrees of severity, which shows the need for early psychological and pedagogical support. Timely correctional work will allow to compensate the existing disorders most successfully by the beginning of educational activity.

The data obtained in the study of the medical, psychological and pedagogical examination of children of 3—8 years old conceived with the help of reproductive technologies shows different variants of neurocognitive development, characterized by the peculiarity of formation of higher mental functions. Therefore, the study of the issue of the possible interrelation of the influence of the fertilization method on the ontogenetic development of the child is extremely relevant. In our study, different variants — from severe underdevelopment to a high normality — were revealed in the designated spheres of development.

Table 4

Speech Disorders in Children of the Experimental and Control Groups Identified During the Speech Therapy Examination

Conclusion

The frequently occurring psychiatric and neurological pathology in children conceived by ART requires

a closer study of different spheres of possible influence (health status of parents, pregnancy and labor period, etc.) on the further development of the child.

A qualitative and comprehensive study of the impact of ART on children’s cognitive and speech development is possible only through an interdisciplinary approach towards the organization of the study. This will allow for a comprehensive and more detailed assessment of the impact of the chosen reproductive method on the child’s further development. Combining specialists from different fields: fertility specialists, gynecologists, neonatologists, pediatricians, psychologists, and teachers will help to create a more comprehensive picture of the development of children conceived artificially.