Is test-tube baby risky?

Do infertility treatments damage babies'genes? Doctors used to think not．Now they are not so sure．
In the 24 years since the birth of Louise Brown，the world's first test－tube baby，thousands of would－be parents have been assure that as far as scientists knew there was no extra risk of genetic damage associated with in－vitro fertilization，or IVF．No matter how sperm meets egg--whether in a woman's body or in a Petri dish（and even if the sperm needs some help getting inside the egg）--nature is equally vigilant about preventing serious genetic mishaps from coming to term．With those assurances，test－tube births have soared from a few hundred a year in the early 1980s to tens of thousands today．

But according to a pair of reports in last week's New England Journal of Medicine，that conventional wisdom may be wrong．In the first study，doctors in Britain and Australia found that infants conceived with both straightforward test－tube methods and a more invasive technique called intra－cytoplasmic sperm in jection，in which sperm is injected directly into the egg，have an 8.6% risk of major birth defects--including heart and kidney abnormalities，cleft palate and undescended testicles -- compared with the 4.2% rate in babies made the old－fashioned way．The second study，conducted by the U．S．Centers for Disease Control and Prevention（CDC），reported that babies conceived through what doctors call assisted reproductive technologies（ART）have 2.6 times the risk of low or very low birth weight --a significant risk factor for cardiac and cognitive problems．

There are plenty of reasons to take both studies seriously．In the low－birth－weight study，for example，the researchers allowed for the fact that parents who use assisted reproduction tend to be older than average and to have more multiple births--twins，triplets and so on．Even when they corrected for these factors，the disparity between babies conceived through ART and those conceived normally remained．

But there's no need to panic．Independent experts are quick to point out that the reports are hardly definitive．Couples who seek reproductive help are not just older；they are also--though it may seem like stating the obvious--infertile．"You're comparing two different groups of patients here，"says Dr．William Schoolcraft，director of the Colorado Center for Reproductive Medicine．"You have women with the disease of infertility，and you're comparing them with women who don't have the disease．"
Some of the same caveats apply to the birth－defects study，say experts．Here，too，earlier research had found no significant differences between test－tube babies and convention－ally conceived kids．And here，again，the new study didn't correct for the fact that women who get reproductive assistance often have something wrong with their reproductive system in the first place．

Even if these new studies are borne out by later research--already under way in infertility programs in Australia and the U．S．--the risks to kids conceived by assisted reproduction remain reassuringly small．And even if the danger is twice what doctors previously believed，91% of ART babies would still be born perfectly healthy．Says Dr．Zev Rosenwaks，director of New York Presbyterian Hospital's infertility program："If you ask a couple if they would rather not have a child at all or try to have a child that over 90% of the time will be normal，I think they will choose to have the child．"