In vitro fertilization and the cloacal/bladder exstrophy-epispadias complex: a continuing association.

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.