***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The use of a gonodotropin-releasing hormone ( Gn-RH ) agonist in an in vitro fertilization ( IVF ) program raises the question of any influence on the physical , neurologic , and mental development of the children . We compared the development of children born after long-acting Gn-RH agonist treatment with that of children born after spontaneous pregnancies . Children from singleton pregnancies and > or = 28 months of age were examined by a pediatric neurologist and a psychologist who did not know to which group the children belonged . The General Cognitive Index test was used . Each group included 30 children . Five children cooperated only partly . Physical and neurologic findings were normal in all children , except that one in the group born after in vitro fertilization had diffuse hypotonia , attention-deficit hyperactivity disorder , and hyperactivity . The General Cognitive Index for the 26 children in the study group and the 29 children in the control group who fully cooperated were 102 + /- 13.3 and 106 + /- 13.5 , respectively ( p = 0.37 ) . The verbal perception , motor , and memory indexes were not significantly different . We conclude that the long-acting Gn-RH agonist had no clinical ly identifiable influence on the development of these children OBJECTIVE To determine the growth and physical outcome at 2 years of age for children born after assisted reproductive techniques in the state of Victoria . DESIGN Using a case-matched control study between January 1991 and July 1993 , 314 children ( 196 singletons , 47 sets of twins , 8 sets of triplets ) conceived after in vitro fertilization ( IVF ) and related techniques at the Monash IVF and Royal Women 's Hospital Reproductive Biology Unit and 150 control children ( 113 singletons , 17 sets of twins , 1 set of triplets ) r and omly selected from the general population using the Victorian Perinatal Data Collection Unit records were enrolled to be examined for minor dysmorphic and major organ abnormalities . Singleton and twin cases were matched for plurality and gestation and date of birth . Triplets were not matched . RESULTS IVF status was not a significant independent factor for physical outcomes , including malformation rates , nor for days of hospitalization postdischarge and operations . There was no significant interaction between IVF status and mean percentiles for weight and head circumference . The IVF group had a greater mean length percentile . Twins in both groups had significantly poorer physical outcomes than singletons on some measures . CONCLUSION This study did not demonstrate an independent IVF effect on the growth and physical outcome of children at 2 years of age when matched for plurality and gestation . The poor outcomes where noted were related to the effects of multiple births . These findings must be viewed in context of the response rates and therefore representativeness of the data . The need for longitudinal studies is demonstrated OBJECTIVE To measure the use of infertility treatments in the general population and their association with neonatal health . DESIGN Cross-sectional , population -based study . SETTING Canton of Vaud , Switzerl and ; Etude du Developpement des Nouveau-nés ( EDEN ) , a prospect i ve study of chronic childhood conditions . PATIENT(S ) Six thous and four hundred seventy-seven live newborns ( 6,379 pregnancies ) delivered of residents of Vaud in the 19 maternity hospitals between 1993 and 1994 . MAIN OUTCOME MEASURE(S ) Neonatal morbidity , multiplicity , low birth weight , prematurity , intrauterine growth retardation , transfer to intensive care , and length of hospital stay . RESULT ( S ) Infertility treatments were reported for 2.1 % of pregnancies ( 129 women , 148 newborns ) and were associated significantly with adverse outcomes . Population -attributable risks varied from 3%-20 % . The outcomes of twins did not differ regardless of whether their mother was treated for infertility . Among singletons , only low birth weight was significantly more frequent when infertility treatments were used . Unadjusted odds ratios for neonatal morbidity were significant only for multiple births ( 2.56 ; 95 % confidence interval 1.21 - 5.42 ) . This association was not influenced by maternal characteristics and it disappeared after controlling for sex , gestational age , and birth weight . CONCLUSIONS ( S ) An independent effect of infertility treatments on neonatal morbidity can not be ruled out , but most of their impact appeared to be mediated by multiplicity and prematurity . Reducing the number of medically induced multiple pregnancies is the most effective prevention of neonatal morbidity related to infertility treatments . Follow-up studies are needed OBJECTIVE To describe the characteristics of pregnancies and children at birth result ing from IVF-ET  and to assess whether they differ from those after natural conception . DESIGN Prospect i ve multicenter survey . SETTING A national registry , representing 80 % of all French IVF-ET activity for the period 1986 to 1990 . PATIENTS Data on 7,024 pregnancies , 5,371 deliveries , and 6,879 newborn infants . INTERVENTIONS A form is completed for every clinical pregnancy . MAIN OUTCOME MEASURES Spontaneous abortion , ectopic pregnancy , multiple pregnancy , prematurity , hypotrophy , perinatal and neonatal mortality , and congenital malformations rates . RESULTS The spontaneous abortion and ectopic pregnancy rates were , respectively , 17.6 % and 5.8 % . More than a quarter ( 26.8 % ) of the deliveries were multiple births . The preterm birth rate ( 29.3 % ) , the low birth weight rate ( 36.2 % ) , and the perinatal and neonatal mortality rates were higher than the national average . The rate of malformations ( 2.8 % ) was comparable with the general population ( 2.1 % ) . CONCLUSION Assisted conception frequently results in multiple pregnancy , and this is the main determinant of pregnancy outcome . Nevertheless , it is not the only risk factor for prematurity , which is also more frequent among IVF singleton newborn . The prevalence of congenital malformations is not higher than after natural conception There is an ongoing discussion regarding conflicting data on malformation rate in children born after intracytoplasmic sperm injection ( ICSI ) .  A prospect i ve , multicentric , control cohort study was done in Germany . Fifty-nine centres prospect ively recruited pregnancies before the 16th week of gestation , which were included in the study if they were ongoing beyond this time . Children were examined according to a st and ardized procedure . A control cohort of children conceived spontaneously was taken from a prospect i ve birth registry ( Mainzer Modell ) , where children were examined according to the exact same criteria as the ICSI cohort . Major malformation rate was calculated , based on data of all liveborn and stillborn children , as well as on all spontaneous and induced abortions , beginning with the 16th week of gestation . In the ICSI cohort , 8.6 % of infants ( 291/3372 ) , and in the control cohort 6.9 % of infants ( 2140/30940 ) , had a major malformation . This result ed in a crude relative risk ( RR ) of 1.25 ( 95 % confidence interval 1.11 - 1.40 ) . There was no influence of sperm origin on major malformation rate in children born after ICSI . There is an increased risk for a child born after ICSI to have a major malformation compared with a child that has been spontaneously conceived . Based on knowledge of the early developmental steps following ICSI , as well as on data of conventional IVF in general , it is assumed that this increased risk is due to parental factors causing the infertility , which has led to ICSI in the first place A prospect i ve series of 90 consecutive pregnancies ( 70 singleton , 16 twin and 4 triplet pregnancies ) result ing in births of 114 infants after in vitro fertilisation ( IVF ) at Rigshospitalet were compared to a control group of pregnancies and deliveries in 70 non‐IVF infertility patients with singleton pregnancies and 20 women with normal fertility with twin ( n=16 ) or triplet ( n=4 ) pregnancies . No differences in the incidence of third trimester pregnancy complications , abnormal fetal karyotypes or malformations were found . The number of women with spontaneous onset of labor and the gestational age at delivery were similar in the IVF and control groups . In singleton deliveries , the birth weight was lower ( p<0.025 ) in the IVF group ( median 3145 g , range 8904300 g ) than in the control group ( 3399 g , 2592–4850 g ) , whereas in multiple gestation similar birth weights were found in the IVF and control groups . We conclude that the birth weight in singleton deliveries after IVF is lower than the birth weight in infertility patients treated differently . The cause of this difference remains obscure To assess the physical and mental development of infants born after in vitro fertilization ( IVF )  , we performed a general physical and developmental examination ( Bayley and Stanford-Binet scales ) on a cohort of 116 IVF children , conceived and born at our institution between February 1985 and March 1989 , and on 116 non-IVF matched controls . Study and control groups were each composed of 66 singletons , 19 pairs of twins and 4 sets of triplets , whose age at examination ranged from 12 to 45 months . The developmental indices of IVF infants were within the normal range and did not differ from those of their matched controls . The indices were positively correlated to gestational age , birth weight , head circumference at birth and at examination , and mother 's education . Mean birth weight , gestational age , and birth weight percentile of IVF infants were lower than the mean of the healthy population . Mean percentiles of weight and length at examination ( mean age 22.4 months ) were equally low but did not differ from those of the matched controls . However , mean percentiles of head circumference at birth and at examination compare well with the normal mean , both in IVF and control groups . Twins and triplets ( IVF and controls ) had significantly lower physical and mental indices as compared to singletons Health outcomes during the first year for 95 infants born following in-vitro fertilization ( IVF ) were compared with those of 79 naturally conceived controls whose mothers were of identical parity and similar age . Primigravid women were enrolled prospect ively at 30 weeks gestation , perinatal and neonatal data were collected during pregnancy and following birth , and details of health care re source use were obtained from mothers at 4 and 12 months . Median ( range ) number of medical problems during the first year tended to be less for IVF infants , 4 ( 0 - 41 ) versus 5 ( 0 - 12 ) ( P = 0.07 ) , whilst total number of visits to health care workers was similar for IVF and control infants , 19 ( 2 - 47 ) versus 19 ( 1 - 47 ) . IVF infants were more likely to have an excessive number of visits to Early Childhood Health Care Centres [ odds ratio ( OR ; 95 % confidence interval , CI ) = 2.44 ( 1.11 - 5.56 ) ] , but less likely to have an excessive number of visits to general medical practitioners [ OR = 0.45 ( 0.22 - 0.93 ) ] and other health care workers [ OR = 0.48 ( 0.23 - 0.99 ) ] . These data provide some degree of reassurance about medium-term health outcomes for children conceived using IVF . Although they are more likely to utilize the re sources of neonatal intensive care units , IVF infants do not appear to have an increased number of medical problems or to over-utilize health care re sources during the remainder of their first year of life OBJECTIVE To assess the somatic , psychomotor , and intellectual development of children conceived through intracytoplasmic single sperm injection ( ICSI )  over the whole preschool period . DESIGN Prospect i ve , controlled , cohort study . SETTING Fertility clinic in Brussels , Belgium . PATIENT(S ) Sixty-six ICSI-conceived children prospect ively compared with 52 IVF-conceived and 59 spontaneously conceived children . All children were full-term singletons . INTERVENTION(S ) Home visits by a trained psychologist . St and ardized interviews . Assessment s using the revised Brunet-Lézine scale and the revised Wechsler preschool and primary scale of intelligence . MAIN OUTCOME MEASURE(S ) Physical growth and general health . Formal developmental and intellectual assessment s. RESULT ( S ) Children conceived by ICSI were healthy : no significant differences appeared in the incidence of combined congenital malformations ( 11.3 % ) , health problems ( 44.1 % ) , surgical interventions ( 18.6 % ) , and hospitalizations ( 6.8 % ) , nor for the developmental assessment s ( mean developmental quotient at 9 months : 93.9 ; at 18 months : 102.0 ) . For the intellectual assessment s , the between-group differences disappeared when adjusted for levels of parental education ( mean intelligence quotient at 3 years : 97.0 ; at 5 years : 103.3 ) . CONCLUSION ( S ) This pilot study shows that throughout the preschool period , ICSI-conceived children have psychomotor and intellectual development similar to that of IVF-conceived and spontaneously conceived children . These conclusions need to be confirmed by multicenter studies BACKGROUND Intracytoplasmic sperm injection ( ICSI ) was introduced 
    Output:
    
Pooled results from all suitable published studies suggest that children born following ART are at increased risk of birth defects compared with spontaneous conceptions .