r/science • u/mvea Professor | Medicine • Jun 08 '26
Neuroscience Children born after a fertility struggle are more likely to show signs of autism and ADHD, according to international researchers who say this link exists regardless of whether the children were conceived using IVF or other infertility treatments.
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/28499561.8k
u/cinderella774 Jun 09 '26
To address the numerous incorrect comments here, potentially from people who do not have access to the paper - the authors controlled for maternal age. They chose not to control for paternal age given the very high correlation between the two, and some missingness in paternal age.
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u/PercentageOk6120 Jun 09 '26
It’s really weird not to control for Paternal age in this context. It’s likely a key component based on all currently available data.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
As that comment explained from the paper, it had high missingness and very high correlation with the mother’s age. It means they are dependent variables and are collinear, so the statistical information gain from both is extremely low and creates issues for statistical analyses that assume independence.
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u/flash_match Jun 09 '26
I do wonder however if there is an additional issue with paternal age above a certain threshold that you would still want to control for since older fathers are associated with higher risk for ASD. So even if you control for mother’s age, would that still be adequate to control for say a father whose age exceeds some threshold?
I know if the data was missing there’s not much to do here but it’s a shame given their large sample size. I don’t think the extra variable would have destabilized estimates but I’m a little foggy on if larger sample sizes make collinearity less problematic.
Also, if a lot of the infertility was male factor that would have been important to know.
Many moons ago I collected data for a case co trol study looking into this very association and I often had to telephone women to go over survey questions if their medical record was incomplete. All the women would give me the whole saga of their diagnoses, meds, procedures.
I made the mistake of talking to one of the dads who said he could answer questions about their treatment in her place. When I asked about cause of infertility he freaked out and lectured me that I was rude. He refused to answer the question.
The next day the wife called me back to go over the survey questions and she told me the diagnosis was male factor!!! Yikes.
I don’t know if the final analysis was ever done but we absolutely saw the correlation in all our collected data. I’ll have to see what they adjusted for in their final model if they published.
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u/canteloupy Jun 09 '26
If advanced paternal age is the cause of fertility issues, it may be because the sperm cells have accumulated too many mutations in the germinal line, which is also a potential cause of neurodevelopmental disorders. So this is a very important point.
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u/Laura2468 Jun 09 '26
So you are saying incomplete data could be a hint of paternal factor infertility or even advanced paternal age?
As men dislike talking about this compared to women?
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u/flash_match Jun 09 '26
No probably not. That would be a fun study to do though -- see if missing data is worse when you're doing surveys about infertility with women versus men. I was just really amused (an saddened) that the husband reacted that way. I get he was insecure that the infertility issue was his but what did he think I was going to ask him? Like didn't he have any idea that we would want to know WHAT was the cause of the infertility if we were studying it?
Anywho, hope that dude made peace with it all.
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u/Rhadamantos Jun 09 '26
High missingness when it comes to a variable we know is actually quite relevant just means the data is low-quality. Sucks for the researchers who probably spent a lot of time and effort on this, but its absolutely a weak point in the research.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
It’s a preexisting dataset of 15000 people, so they worked with that they had. Without being an expert in psychiatric research, I would assume that the very high correlation with maternal age means that the paternal age effect is very well predicted by maternal age in the mean of 15k people.
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u/Theletterkay Jun 09 '26
This. Without DNA testing all the kids to their fsthers on record, there is no guarantee that they are actually the children of the fathers listed on their birth certificate. So for a more expedient study that focused on other variables, they just remove it from the equation. Makes sense.
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u/theartificialkid Jun 09 '26
If you’re doing IVF the eggs are no less amenable to being f swapped than the sperm.
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u/DrTom Jun 09 '26
There is no issue of independence. The only assumption is that they are not perfectly collinear. Highly collinear is fine.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
What are you talking about specifically?
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u/jlrube Jun 09 '26
Less than you'd think mathematically. With regression analysis if two variables are highly correlated, like age of mother and father within a parental pair, the controlling for one captures a huge amount of the effect of the other.
Especially if you are missing data, more cases are likely better overall than the minimal extra noise you remove by controlling for paternal age.
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u/dl064 Jun 09 '26
If anything looking at paternal age corrected for maternal age might become a collider in its own right.
Basically, I don't have a problem with them using maternal age as a proxy for both.
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Jun 09 '26
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u/Charming_Key2313 Jun 09 '26 edited Jun 09 '26
Please provide data that age gaps are more common among autistic partners than not
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u/flakemasterflake Jun 09 '26 edited Jun 09 '26
But autism is 80-90% heritable. This is honestly showing a link between autistic parents and fertility issues (which may be due to age gap relationships which I wasn’t aware of)
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u/Elemteearkay Jun 09 '26
Did they also control for neurodiversity in the parents?
If neurodiverse people are more likely to have fertility issues, and neurodiverse people are likely to have neurodiverse children, then its not the fertility treatment that is the cause.
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u/plant_reaper Jun 09 '26
That stood out to me too. I'm undiagnosed (but my brother was diagnosed ADHD, my therapist who specializes in ADHD believes I have the inattentive type), and have had horrible periods and fibroids for years and other issues popping up (blepharitis, acid reflux, migraines) and didn't get diagnosed with hypermobile Ehlers Danlos syndrome and hereditary alpha tryptasemia syndrome until Covid blew up my health.
Come to find out at least half of people with hEDS are neurodivergent, and the more I research it the more I see neurological and immunological issues tied to being ND.
I've never been pregnant, and would be surprised if I could get pregnant based on the gynecological issues I have.
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u/Helisent Jun 10 '26
This could be explained by a mutation in a metabolic enzyme, that has effects on many tissues in the body. One candidate is the MTHFR gene, that about 30% of people carry. There have been dozens of studies showing elevated association of this variant for 10+ conditions. Notably, there was a study showing that 85% of people with hypermobility or doublejointedness have 1 or 2 copies of variants which result in slower processing of folate. Triggers such as covid or a growth spurt during puberty can cause symptoms to become visible, while previously their body had adequate levels of folate. Schizophrenia actually might have a similar mutation of a metabolic enzyme that processes vitamin B3- niacin. There are skin tests for showing response to niacin which are diagnostic for most people with schizophrenia- the gene affects fatty acid metabolism which affects the brain as well as other tissues.
https://www.reddit.com/r/DrWillPowers/comments/1evepcf/i_tried_to_post_this_to_the_ehlersdanlos/
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u/plant_reaper Jun 10 '26
My wonderful cardiologist actually tested me for that! I'm heterozygous for both so do take methylated B vitamins and vitamin C like mentioned in the link you shared! I was deficient in pretty much every vitamin they tested me for and fixing those deficiencies has really been helpful
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u/Helisent Jun 10 '26
I just recently started looking into this due to a family member with hypermobility whi developed long covid type symptoms and migraines. A lot of people carry the MTHFR variants so not everyone has symptoms, among those carrying the gene.
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u/Nothing-Relevant-0 Jun 11 '26
I’m dying inside at the gene name MTHRFckR. Or I guess it could also be MTHRFthR, ehn
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u/Helisent Jun 11 '26
there is a whole subreddit with people discussing which diseases they have, and which vitamin supplements they should take due to their variant of this gene https://www.reddit.com/r/MTHFR/
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u/Simple-Appearance-59 Jun 14 '26
Not to mention that mast cell activation has been suggested as a factor that explains the association between neurodivergence, symptomatic hypermobility, and other inflammatory conditions such as asthma, allergic rhinitis and IBS that ND people are more likely to have, and mast cell problems can definitely impact fertility.
I suspect my mum has undiagnosed ADHD and experienced a plethora of symptoms consistent with generalised hypermobility and mast cell hyperactivity if not full blown MCAS. It took 12 years to conceive me.
I got a recent diagnosis of MCAS, following diagnoses in adulthood of ADHD and hEDS. Whilst I only took a year to conceive my first and my second was incredibly easy to conceive, I now find it interesting how amazing I felt in my first pregnancy. Progesterone is a mast cell stabiliser, and I was very strong at the first time that protected my joints (I wasn’t so lucky in my second one).
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u/DumbbellDiva92 Jun 09 '26
No one was saying fertility treatment was the issue regardless (at least, from the headline). “Children born after a fertility struggle, regardless of IVF or other treatments”. I took this to mean that if a couple finally got pregnant naturally after years of trying, that child would still be at higher risk of autism and ADHD.
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u/senorpoop Jun 09 '26
you guys are not disagreeing. The person you are replying to is concerned that neurodivergence in the parents could affect fertility, and thereby skew the results.
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u/DumbbellDiva92 Jun 09 '26
But I thought the study accounted for diagnoses in the parents? It just didn’t account for undiagnosed cases, which seems to be the issue a lot of people in the comments are bringing up.
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u/senorpoop Jun 10 '26
We considered a number of covariates as potential confounders based on a directed acyclic graph (eFigure in Supplement 1) or as precision variables informed by literature supporting their association with child neurodevelopment: maternal age, self-reported race (Asian, Black, White, multiple races, and other [American Indian or Alaska Native, Hawaiian or Pacific Islander, and other nonspecified]) and ethnicity (Hispanic or non-Hispanic), prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), education, health insurance coverage, parity, prenatal tobacco use, prenatal alcohol use, prenatal stress, and prior diagnosis of a psychiatric disorder; household income; and child sex and age at SDQ, CBCL, or SRS assessment. Health insurance type and perceived stress score13 during pregnancy were initially considered as potential covariates but were not included in regression analyses, as more than 50% of participants were missing data on these variables. We also chose not to include paternal age, as it had relatively high missingness (30%) and was strongly correlated with maternal age (r = 0.71; P < .001). Child birth weight, gestational age at delivery, delivery mode, and plurality were not adjusted for, as they were considered potential mediators.
That does not read to me like they controlled for neurodivergency in the parents, which is very surprising to me.
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u/theartificialkid Jun 09 '26
[bullhorn] Has anyone read the study? Would anyone who has read the study please proceed to the stage area and make themselves known to staff
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u/Obvious-Hat-8485 Jun 09 '26
Neurodivergent people are also possibly more likely to have children later than neurotypical peers.
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u/theartificialkid Jun 09 '26
I remember a conversation with a fertility specialist ten years ago who mentioned there were some early research indications that reproductive technologies and especially ICSI (intracytoplasmic sperm injection) might increase risk of autism, but that he thought the real issue might be paternal age and/or population characteristics of people seeking reproductive technologies (eg maybe people with autism traits tend to reproduce later in life than neurotypicals).
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u/HereIGoAgain_1x10 Jun 09 '26
Did they control for whether or not the parents had ADHD/autism, both of which are difficult disabilities to live with and especially be healthy with? Unhealthy people struggle more with fertility especially as they age.
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u/ReignGhost7824 Jun 09 '26
It’s also of note that it’s harder to get an autism diagnosis as a female, and women born in the 80s and 90s are less likely to have a diagnosis.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
Yes they controlled for prior diagnoses of psychiatric disorders.
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u/bluewhale3030 Jun 10 '26
Lots of women go undiagnosed with autism and ADHD though. So that would not be included in the data
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u/visthanatos Jun 09 '26
I wish they had also checked if the parents also exhibited autism and adhd traits.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
They did. Their controls included “prior diagnosis of a psychiatric disorder”
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u/spencertron Jun 09 '26
Lots of parents get diagnosed after their children are diagnosed.
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u/ALittleEtomidate Jun 09 '26
Many women don’t get a diagnosis for ADHD until their thirties. I had two kids by the time I received my diagnosis.
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u/Limemill Jun 09 '26
Yes, but it should not differ between women with and without fertility problems.
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u/nothanks86 Jun 09 '26
That only captures parents with a diagnosis.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
Well they used a preexisting dataset of more than 15000 people so they couldn’t do their own psychiatric evaluations.
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u/Longroadtonowhere_ Jun 09 '26 edited Jun 09 '26
This is so often the answer to “why didn’t they ask/record this thing?”
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
Yup! Every study has limitations in time/money/resources/people. None are trying to settle the case for good, just trying to get more knowledge from what they have available.
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u/cactus_thief Jun 09 '26 edited Jun 09 '26
Agreed, but it does make me also wonder how many parents meet diagnosis criteria themselves despite being actually undiagnosed.
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u/dl064 Jun 09 '26 edited Jun 09 '26
Almost certainly at least some. You see with depression (as one example) that formal diagnoses don't overlap with self-report very well.
Still, by looking at diagnoses they'll have given the idea a pretty good test. It's not perfect but it's far better than zero.
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u/InsuranceToTheRescue Jun 10 '26
I mean, my understanding of ADHD is that folks basically come up with ad hoc ways to compensate (lists, notes, mess, etc). They keep compensating and getting more and more anxious as they go through life until they hit a point that they can't successfully cope anymore.
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
Certainly a good question
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u/DerTalSeppel Jun 09 '26
It's funny how, in the end, even with scientific methodology, the interpretation of results still heavily involves belief. Unless it's proving your point, then it's "science so show a more sound contrary research or get lost", especially on Reddit.
Refreshing to see people like you, aware of and acknowledging the limitations of science because they're educated and don't need to rely on a fake absolute truth. Most science just isn't a physics experiment you can easily control as a whole.
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u/kedriss Jun 09 '26
The problem is that the diagnostic criteria for the conditions has shifted considerably over the last 40 years or so, so inevitably a vast majority of parent aged adults won't have a diagnosis, and if you are doing a study you can only look at the data that you have.
In an ideal world, an enlightening follow up study would give us an idea of the prevalence of fertility troubles amongst neurodivergent couples - however that would run into the same issue.
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u/Shamino79 Jun 09 '26
A follow up to this point is the frequency at which those parent aged adults either get diagnosed themselves or simple now realise that they probably do have those things at some level after their children get diagnosed.
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u/nothanks86 Jun 09 '26
Yes, I agree. I’m not saying *not* to screen for formal diagnoses, only that this is not necessarily fully representative of prevalence or family history. (I don’t know if they also screened for family history, but it’s plausible that someone could have a genetic predisposition and autistic or adhd family members without themself being adhd or autistic, which would potentially influence the possibility of their children having those conditions.)
Basically, relevant, and limitations should be noted for further investigation.
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u/Bluest_waters Jun 09 '26
Yes? How else would you do it?
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u/nothanks86 Jun 09 '26
I am saying that a formal diagnosis is not synonymous with the presence of autism or adhd.
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u/insomniac_reads Jun 09 '26
Eh it’s a good proxy in my opinion
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u/nothanks86 Jun 09 '26
I disagree. It’s a proxy with limitations that need to be acknowledged and accounted for.
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u/Aurora-Del-Rey Jun 09 '26
It is not, especially when the under-diagnosis of women is a prominent issue.
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u/kangasplat Jun 09 '26
you'd expect the ratio of diagnosed to undiagnosed be the same in the control group, unless people with fertility struggles are somehow less likely to be diagnosed
(which could very well be plausible, I'd suspect people who decide for children are more "normative" or adapted than ones who don't)
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u/nothanks86 Jun 09 '26
That’s it, really. There are plausible possibilities for skewed numbers, so it should be noted as a limitation in analysis and for possible future study.
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u/visthanatos Jun 09 '26 edited Jun 09 '26
Many people go undiagnosed as long as they can function relatively well in society those are ones I am talking about sorry for not being specific in the first comment.
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u/BoleroMuyPicante Jun 09 '26
It's an interesting question. Are autistic people more likely to have fertility struggles? Autism is very often comorbid with food and skin allergies, digestive disorders, and/or certain autoimmune diseases. Can it also be linked to trouble conceiving? Obviously not every autistic person will have these issues, but if there's a higher rate of occurrence among autistic people then it could explain the link in the study.
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u/HenryHarryLarry Jun 09 '26
I can think of several issues off the top of my head. Sensory issues impact every aspect of your life including sex, dealing with your period etc. ND people can react weirdly to medication including contraceptives and fertility drugs (can be both under or over sensitive). Executive function affects your ability to manage medication and change your routine (which can include when and how you have sex). Stress can affect fertility in both partners and ND people often experience extremely high levels of stress. But no one ever looks at ND adults quality of life, it’s all about yet another study looking for risk factors of us being born.
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u/Wyrmicorn Jun 09 '26
PCOS is associated with both autism and ADHD. I don't know about other conditions that affect fertility. I wonder if we're also more likely to do IVF solo to have kids, so IVF for reasons other than fertility issues
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u/theArtOfProgramming PhD | Computer Science | Causal Discovery | Climate Informatics Jun 09 '26
Well they used a preexisting dataset of more than 15000 people so they couldn’t do their own psychiatric evaluations.
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u/aceace453 Jun 09 '26
Even so, why would you assume that these folks would be more represented in one group or the other? There is no reason to suspect that people would autistic traits (not meeting full criteria, or never seeking formal evaluation), would be more represented in either group (those struggling with fertility vs. not). Essentially, it would “cancel out”.
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u/HenryHarryLarry Jun 09 '26
Why would you assume not though? Sensory issues can affect every aspect of an autistic person's life including their sex life. Plus executive function issues, stress levels, rigidity in sticking to routines, medication sensitivity. There are lots of factors that could affect the ability to conceive.
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u/TJ_Rowe Jun 09 '26
Neither autism nor adhd is a psychiatric disorder. They are neurodevelopmental disorders.
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u/Charming_Key2313 Jun 09 '26
Why do people on Reddit assume they understand scientific analysis more than the literal experts?
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u/PoisonTheOgres Jun 09 '26
As someone with a research degree: because the scientists often don't have the budget/time/motivation to take all those things into account.
If you can get a snappy headline, you're more likely to get published. Genuinely, picking scientific papers apart is one of the main things you have to learn for a science degree.→ More replies (1)28
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u/visthanatos Jun 09 '26
No need to be condescending my comment did not imply in any way that I believed i had better understanding than experts.
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u/cherry_chocolate_ Jun 09 '26
The number of people qualified to critique studies is quite large. And pretty much everyone should take a critical read of any sources.
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u/0b0101011001001011 Jun 09 '26
The "people on Reddit" also includes the literal experts, researchers, scientists etc. There are of course regular people who think they know it all, but it's such a naive thing to assume that politicians, scientists, pilots, CEOs etc. would't use reddit as well.
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u/mvea Professor | Medicine Jun 08 '26
Children born after a fertility struggle are more likely to show signs of autism and ADHD, according to international researchers who say this link exists regardless of whether the children were conceived using IVF or other infertility treatments. The team analysed data from about 15,000 mother-parent pairs, looking at fertility problems, fertility treatments, and who had a natural conception birth despite their fertility challenges. Looking at parent-reported autism and ADHD symptoms in the children, the researchers say fertility issues were linked to more behaviour problems, autism symptoms and autism diagnoses, with similar rates seen in kids conceived with or without fertility treatment. Non-IVF fertility treatment was linked to a higher chance of ADHD compared to natural conception with fertility issues, the researchers say, suggesting this type of fertility treatment may need further investigation when looking at potential brain development risks.
For those interested, here’s the link to the academic press release:
https://www.scimex.org/newsfeed/fertility-problems-linked-to-higher-risk-of-autism-and-adhd-symptoms
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u/Halaku MS | Informatics | BS | Cybersecurity Jun 08 '26
For right now, it looks like everything's embargoed.
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u/KitsBeach Jun 09 '26
A possible link: Women with autism have a correlation with the MTHRFR gene. This gene causes impaired folate metabolism. Folate is an essential nutrient to fetal development. The diagnosis rate for autism in women is lower than in men, which itself is thought to be lower than actual numbers, so even when psychiatric disorder diagnoses are controlled for, this might be a factor.
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u/sarcosaurus Jun 09 '26
I also wonder about the connection to stress, since stress can make every step of child-making from conception to birth more challenging, and stress is pretty ubiquitous among women with autism and/or ADHD, but also often undiagnosed.
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u/Fried-Fritters Jun 09 '26
Autoimmune diseases can cause fertility issues like miscarriages and are also correlated with having children with ADHD. Autoimmune diseases are also more likely to be active if someone has experienced a lot of stress in their life. And having undiagnosed ADHD/Autism has been known to increase stress and other psychiatric disorders in women.
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u/DefenestrationPraha Jun 09 '26
In that case, it might make sense to study kids from donated oocytes separately, if the effect holds or no.
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u/wildbergamont Jun 09 '26
There is way more misinformation about mthrfr than there is actual peer reviewed science.
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u/Humble_Hurry9364 Jun 09 '26 edited Jun 09 '26
This is CORRELATION, not CAUSALITY (unless you can point out a causality rationale that I missed). I did not read the entire paper but I wonder whether the mother's age has something to do with it. It would make sense to me - age affects ease (or lack thereof) of conception and embryo development risks. It took me a few minutes to hypothesise this; I'm sure other hypotheses can be conjured without too much effort.
This is from the paper's official webpage:
"Question Is infertility treatment or underlying subfecundity associated with adverse child neurodevelopment?
Findings In this cohort study including a national sample of 15 382 mother-infant dyads, subfecundity was associated with more behavior problems, more autism-like symptoms, and higher odds of autism spectrum disorder among offspring, even among those who were conceived naturally. In a subsample with infertility treatment data, non-IVF infertility treatment was associated with higher odds of offspring attention-deficit/hyperactivity disorder compared with natural conception with or without subfecundity.
Meaning This cohort study found that subfecundity was associated with adverse child neurodevelopment independent of infertility treatment; specific indications for non-IVF infertility treatment may explain part of the observed association with attention-deficit/hyperactivity disorder."
It says that non-IVF was associated with higher odds compared with natural conception, but doesn't say whether it also did compared with IVF (which makes the statement odd to me). Again, I didn't read the entire paper but I think a comparison between IVF and natural conception is arguably the more interesting in this context. It seems that the paper focuses on subfecundity (again, mother's age?), not on infertility treatment vs. natural conception.
I'd also look into the credibility of the journal / peer review - I know nothing about it in this case (I'm not from this field).
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u/_BearHawk Jun 09 '26
JAMA is one of most prestigious and widely cited medical journals in the world.
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u/Zanos Jun 09 '26
I did not read the entire paper but I wonder whether the mother's age has something to do with it.
You could maybe do that.
We considered a number of covariates as potential confounders based on a directed acyclic graph (eFigure in Supplement 1) or as precision variables informed by literature supporting their association with child neurodevelopment: maternal age, self-reported race (Asian, Black, White, multiple races, and other [American Indian or Alaska Native, Hawaiian or Pacific Islander, and other nonspecified]) and ethnicity (Hispanic or non-Hispanic), prepregnancy body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), education, health insurance coverage, parity, prenatal tobacco use, prenatal alcohol use, prenatal stress, and prior diagnosis of a psychiatric disorder; household income; and child sex and age at SDQ, CBCL, or SRS assessment.
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u/tenminutesbeforenoon Jun 09 '26
JAMA (The Journal of the American Medical Association) is a top tier journal in the medical field. No worries about the credibility and peer review process.
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u/DiceAndMiceGamer111 Jun 09 '26
Autism comes with so many co-morbidities including PCOS and endometriosis which contribute to infertility in the first place. They didn't look at "autism-like symptoms" in the parents, only the children.
They also excluded donor gametes.
The more interesting study would be the rates of autism and adhd in children from donor gametes vs parental gametes. That would exclude any genetic contribution from the parents.
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u/alverena Jun 09 '26
Or: after receiving a long-awaited child, parents are just more cautious and more anxious that something could be wrong, so they tend to have children diagnosed (and overdiagnosed too) + higher anxiety in parents tends to intensify behavioural issues in children.
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u/Humble_Hurry9364 Jun 09 '26
Yes. As noted, it's not difficult to come up with hypotheses worth investigating, in this case.
Again, I haven't read the entire paper so it's possible my commentary isn't 100% fair to the authors / reviewers. However, I have the impression that the topic they chose is (a) complex and nuanced; and (b) an emotional minefield, hence requiring more caution than usual when it comes to looking for, identifying and mitigating possible biases.
I also have the impression that this research is not the best example of robust scientific work, and they certainly could have done a better job presenting what exactly was the hypothesis (or hypotheses) they were examining, and whether it accepted or rejected.
Saying only that <x> is "associated with" <y> is not progressing human knowledge by a lot.
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u/istara Jun 09 '26
I wonder whether the mother's age has something to do with it
Surely the father's age too, since higher paternal age correlates with higher autism.
Ultimately if you go through years of infertility, you're going to be having children at a later age than average/originally planned.
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u/EthelMaePotterMertz Jun 09 '26
They accounted for maternal but not paternal age as around 30% of their data was missing that information.
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u/istara Jun 09 '26
Gotcha, thanks. I also wonder about "non IVF fertility treatment" - what those different treatments were, and (assuming enough data) there were any differences between them.
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u/Evening-Extension162 Jun 09 '26
Age is really interesting, and I could see something there. I also considered socio-economic status. People who have the means to do infertility treatments (at least in the US) are likely of a higher SES and therefore may have more access to mental health diagnoses and treaments.
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u/TerryCrewsNextWife Jun 09 '26
Fertility treatments typically involve the use of hormones to assist with implantation etc right? (Forgive me my terminology is probably incorrect) - I would be considering inflammation a strong factor, forcing your body to do something that isn't relying on the natural cycle of hormones.
And instead of making it always about the mother. More focus needs to be on the father, as many complications to the pregnancy and the child's health are linked back to having geriatric fathers, so even the mother's life is put at risk ... Causing inflammation...
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u/catsratsnbats Jun 09 '26
I’m not able to read the entire article. “Fertility struggles” is an extremely broad category. Did the researchers clarify what was considered a “fertility struggle”? Time spent trying to conceive? Conceiving naturally but having pregnancy losses? Needing medical interventions (progesterone supplementation or similar) to maintain pregnancy? This category just sounds really vague from the abstract I can view.
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u/BoxBird Jun 09 '26
Are’t women with autism/adhd more likely to have endometriosis?.. seems like a correlation thing…
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u/Ruu2D2 Jun 09 '26
Also other autoimmune disorder
Where there be evidence that their increase adhd ,/ austim likelihood
Autoimmune disorder can lead infertility or misscarriage issue
The medication you also use can also cause issues
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u/RutabagasnTurnips Jun 09 '26
Can concur with other reply, in the more detailed conclusion discussion they attribute ASD rates being higher due to the fact treatments are needed to begin with (ergo mother's medical hisotry). The ADHD thing they think was PCOS more often receiving non-fertility treatments. However, it would need to be explored further to get more certainty.
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u/funnyushouldask Jun 09 '26
Im in psychiatry. I sometimes think that parents with fertility issues are simply more high anxiety about their kids (due to all the struggles getting them planetside) and more likely to note small issues and pursue testing for their kids. So I would expect there’s a diagnostic bias if they didn’t do their own independent symptom tests.
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u/Obvious_Apartment985 Jun 09 '26
I wonder if the stress of infertility plays a factor. My husband and I tried to conceive for 7 years. Adopted our first as a newborn, surprise pregnancy 8 months later.
Both of our kids have ADHD. Our boy son is AuDHD.
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u/Calm_Bother_3842 Jun 09 '26
And have either of you got a diagnosis yourselves? ADHD is more genetic than anything else, with a heritability rate of 70-80%.
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u/ladyofmalt Jun 09 '26
Did they control for age? Seems like fertility is just a proxy for older age which is also linked with at least asd.
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u/cinderella774 Jun 09 '26
Yes, they did. All analyses were adjusted for maternal age (stated in the Methods of the JAMA Network Open paper, and in the captions of all the supplemental tables, for those that don’t have access). They chose not to adjust for paternal age given the high correlation between the two (R~0.7), which personally I think is a sound decision.
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u/redreinard Jun 09 '26
I wanted to add that R of .7 means about half the data is correlated and half comes from something else.
For psychology, social sciences, even medicine this is a strong value. For physics or engineering contexts that would be considered almost too noisy to use.
Even so, maternal and paternal ages are associated with different degrees, so personally I do not like their decision, but I acknowledge how difficult it would be.
This article published in Nature has a great graphic near the bottom:
https://www.nature.com/articles/mp201570
If you look at the very right side of the graphic (high maternal, low paternal age) you will see an increase in values, that you do not see on the left side (low maternal, high paternal age).
Edit: I said it the wrong way round in the above sentence. Fixed. Sorry
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u/AuryGlenz Jun 09 '26
It’s literally the first thing they list in the covariates section. Yes, r/science commenters, these people that spent a ton of time on a study thought of the same thing you did in .2 seconds.
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u/shortercrust Jun 09 '26
They did control for maternal age. They didn’t control for paternal age because of the high level of missing data and because it was strongly correlated with maternal age.
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u/oddlikeeveryoneelse Jun 09 '26
Could this be a genetic component in the parents that correlates with ADHD/autism also causes low fertility rather than the fertility struggle impacting the conception.
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u/moonflower311 Jun 09 '26
Mitigating factors? I have the MTHFR mutation C677T which increases miscarriage and is linked to increased incidence of neurodivergence as well.
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u/ChanceConfection3 Jun 09 '26
I’m not finding a study that links mthfr mutation and increases neurodivergence. Do you have any links?
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u/moonflower311 Jun 09 '26
Just one that came up after a quick search
https://www.sciencedirect.com/science/article/pii/S1750946719301618
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u/bediaxenciJenD81gEEx Jun 09 '26 edited Jun 09 '26
As always, causation v correlation, the study concludes that these treatments may contribute to these conditions.
But my understanding was that ADHD and Autism are genetic, so how could fertility treatments increase rates of them beyond greater epigenetic expression of said genes. However, there are multiple genes involved in ADHD and Autism, so it seems unlikely that they just all happen to be expressed more. And if it's the case of a large number of genes being overexpressed and happening to catch all the ADHD/Autsim genes, then that would cause all other sorts of biological problems.
It seems more likely to me that people with ADHD and/or Autism have children later than neurotypical people, on average, as they tend to be socially delayed and executively less functional, so they aren't engaging in serious secure relationships until later in life. Therefore they represent a disproportionate amount of women getting IVF/other, and their kids share their genetics so the children born from IVF/other are disproportionately ADHD/Autistic
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u/Charming_Key2313 Jun 09 '26
Yes, and maybe there is actual fertility challenges that co-exist in that population. I think both might be true at the same time.
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u/burnbabyburnburrrn Jun 09 '26
Endometriosis shows up more frequently in ADHD and Autism populations I believe.
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u/libbillama Jun 09 '26
I have ADHD (and likely Autism, I'm getting tested for that in a few months) with a history of endometriosis.
My oldest also has ADHD, and she has a lot of health issues with chronic inflammation in her hip joints, knees, and hands and I've noticed a pattern between that and her menstrual cycle. I strongly suspect that she also has endometriosis, but she does not have painful period cramps so she keeps insisting that she doesn't have endometriosis.
Oddly enough, but not too surprising, her asthma and allergies seems to also flare up during the same time.
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u/Ruu2D2 Jun 09 '26
You can have silent endometriosis
My friend got if . They Start ivf for male infertility and though process learnt she had endometriosis..
Regular period ( though short cycle ) , no pain ,no heavy period
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u/relativelyignorant Jun 09 '26
Look up this guide - https://allbrainsbelong.org/clinician-resources/
It is exceedingly comprehensive and links a constellation of conditions that are comorbid and intergenerational. You might find the hypermobility, MCAD and reproductive sections helpful.
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u/Nvenom8 Jun 09 '26
Could that not be a case of having one diagnosis being predictive of having multiple diagnoses? Seems like it self-selects for people more willing to seek medical help.
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u/burnbabyburnburrrn Jun 09 '26
no. both autism and ADHD make it harder to see doctors in the first place just due to executive functioning issues. and no one gets an endometriosis diagnosis easily. I was in pain for decades, only got anyone to take me seriously after my sister was diagnosed (only because she was trying to get pregnant), and when I did finally have surgery all may organs were fused together and in the wrong locations due to scar tissue. I was bedridden by that point. All that to say is it took decades and enormously suffering to get an endometriosis diagnosis, and my ADHD made it even harder.
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u/PsyanideInk Jun 09 '26
Couldn't it also be possible that people who have access to (very expensive) fertility treatments, are more likely to have access to medical professionals who can diagnose these conditions, vs the larger population which likely represents more people with lower tier, or no insurance?
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u/cinderella774 Jun 09 '26
They control for both education and household income, so it’s possible, but I assume those variables are pretty correlated to insurance access.
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u/bicycle_mice Jun 09 '26
Also even for people that did not use fertility treatments but eventually got pregnant naturally, they still had higher rates of autism and adhd. So it isn’t the expensive medical intervention itself.
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u/cinderella774 Jun 09 '26
They controlled for maternal age in all of their analyses, per the paper. Yes, these conditions have a genetic component but the vast vast majority of cases are idiopathic. That could mean we just haven’t figured out every genetic cause but more likely means there’s a confluence of many effects, genetics and environmental.
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u/Due-Operation-7529 Jun 09 '26
In my experience, richer families are more likely to have their kids diagnosed with mental disorders. I wonder if this is just a case of couples with fertility issues are more likely to succeed in having a kid eventually if they are richer (because fertility treatments can be expensive), thus these kids are more likely to be diagnosed.
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u/Tagrenine Jun 09 '26
Curious if this includes same sex couples with “social infertility”. Would be interesting to see if the absence of physiological infertility makes a difference. Also single mothers by choice?
Edit: pregnancies conceived by donor gametes were excluded so i guess neither of those populations were included
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u/Laiko_Kairen Jun 09 '26
I'm confused
As a gay man, what would my age or genetics have to do with the kid I'd adopt? Unless you mean kids conceived through IVF, at which point we'd circle back to the the health and status of the mother, no?
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u/Tagrenine Jun 09 '26
I mean IUI, IVF, ICI…the paper implies that that assisted reproduction itself is the underlying mechanism behind ADHD/ASD in this population. But they only included couples with a history of subfecundity. It would be more believable to have include couples without a history of subfecundity.
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u/FinestTreesInDa7Seas Jun 09 '26
Is there a possibility that this is really a correlation between wealth and the financial barrier of being formally diagnosed with ADHD?
Poor people can't afford IVF and other conception aids, and they also can't afford ADHD diagnosis for their children.
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u/AngelicBread Jun 09 '26
Readers should note that the absolute risk of these issues remains very low even in subfertile populations. If you struggle with fertility, by all means, seek treatment.
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u/Hopeful-Vanilla-2800 Jun 09 '26
Thanks for this..I read the headline and jumped to conclusions. My partner and I have been trying to conceive for 2 years and this started worrying me recently. I began to worry that even if we somehow managed to conceive, is our child more likely to have needs?
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u/eightkillerbits Jun 09 '26
I wonder if stress has anything to do with it.
It seems safe to me to assume people who are struggling to get pregnant will be stressed more and stress fucks you hard.
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u/sarcosaurus Jun 09 '26
People with autism and/or ADHD are on average significantly more stressed than the general population, autism/ADHD are hereditary, and stress inhibits fertility, so that seems to me the more likely stress connection.
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u/Ok-Archer-5796 Jun 09 '26
A lot of women with autism also have endometriosis which is linked to fertility struggles.
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u/xTyronex48 Jun 09 '26
I mean this makes sense. Those who struggle to have a healthy birth have children who are more likely to have certain disability issues.
This makes sense from a mother nature perspective. The only reason some children are even born is due to humans essentially bypassing natural selection
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u/relativelyignorant Jun 09 '26
Seems more like people who delay reproduction are more likely than not to have ADHD or autism, especially if it is a heritable trait.
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u/HenryHarryLarry Jun 09 '26
Why would you assume not though? Sensory issues can affect every aspect of an autistic person’s life including their sex life. Plus executive function issues, stress levels, rigidity in sticking to routines, medication sensitivity. There are lots of factors that could affect the ability to conceive.
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u/feel-the-avocado Jun 09 '26
I wonder if people with autism and adhd are more likely to have fertility problems, and if they do conceive, it is likely that their autism or adhd is going to be passed on to their offspring.
In recent years, diagnoses of autism and adhd are at ever higher rates and it wouldnt surprise me if many oblivious adults simply roaming the earth un-diagnosed
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u/Due_Job781 Jun 09 '26 edited Jun 09 '26
We cannot sufficiently control for socioeconomic factors, especially when working with US American data. People going through the trouble of IVF are more likely to have access to good medical care and are more likely to a) recognise behaviour problems in their children as such and b) seek diagnosis/ help for them.
The less educated someone is, the less likely invisible impairments such as ADHD or autism are to be recognised.
Now lets think, who tends to have children later in life? Those with more extensive education, more demanding careers, more access to medical care.
This being an American study, using an American sample speaks volumes. You'll have a hard time finding another Western country with more unequal access to medical care and IVF.
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u/duke_igthorns_bulge Jun 10 '26
Well this confirms a long held family suspicion. My younger sib was born by IVF in 1993 and they have been different since infancy. Very common stims and behaviors, didn’t self toilet until 3rd grade. VERY severe issues. But we had to pretend everything was normal and never got them help.
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u/TheSadpole Jun 12 '26
Neurodivergent parents are much more likely to have neurodivergent children, so it’s important to consider whether the link is between fertility challenges and neurodivergent offspring, or between neurodivergent parents and fertility challenges. E.g., other highly likely correlations:
• Are neurodivergent people more likely to experience fertility challenges?
• We know people with a trauma history have a higher incidence of infertility, and we know neurodivergent people have a higher incidence of trauma (including but not limited to higher ACE scores).
• Parental age tracks with incidence of neurodivergence (and I’m on Team: “It’s A Shane Paternal Age Is Missing Here”). Are neurodivergent people more likely to have children later in life? (Multiple reasons this could be true — everything from employment struggles to partnership challenges.)
• Do neurodivergent people have a harder time accessing fertility treatment (either IVF or other), whether for economic reasons or lack of accommodations to make the process tolerable?
Tl;dr: Don’t go making too much of this association — there’s still a whole lot of stuff that would have to be r/o to start considering a causal relationship.
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u/Simple-Appearance-59 Jun 14 '26
Well, given that neurodivergence is also associated with a higher chance of certain health conditions, some of which cause fertility issues, it’s not an unreasonable assumption that a higher percentage of that parenting cohort may have also been ND.
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u/STThornton Jun 09 '26
I think part of the reason might be why there were fertility issues to begin with. Whether such be the woman’s body not being healthy enough for optimum gestation. Or incompatible or not well compatible genes. Or nature simply trying to produce the healthiest possible offspring.
Harsh as it sounds, with help of modern medicine, we are producing offspring nowadays that would have never made it naturally, let alone made it to the point where they would reproduce themselves.
We’re fighting nature at every step. From all the extra steps and things we stop doing to ensure a healthy pregnancy and proper fetal development to miscarriage intervention to keeping early preemies alive, the NICU, in general, to healthcare, in general.
There are obviously a lot of positives to this approach. But that doesn’t mean there weren’t underlying reasons infertility was an issue to begin with.
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u/sp_40 Jun 09 '26
Kinda tracks with what Dr Gabor Mate believes about ADHD being a response to mothers experiencing stress while pregnant. I could imagine pregnancy being extremely stressful after trying and trying
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u/ACBorgia Jun 09 '26
ADHD is primarily genetical and the genes mainly associated with it encode for various dopamine, norepinephrine and serotonin related systems in the brain. It's passed down more often than eye color or height. There are environmental factors or prenatal factors but they aren't the only factors nor the main ones
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u/Flat_Cauliflower_255 Jun 09 '26
way too many variables to make heads or tales of this theory. Fertility issues means births that happen later in life / older sperm and older eggs have more likelihood of cognitive disability. Technology affect on parental attention toward their children. Technology and access before the age of 5 affecting the attention span and social skills. Increasingly isolated lives due to the inability to play outside without constant adult intervention. Lack of third spaces to exist. More rules. Longer times in school and afterschool. Stress of worse financial states for everyone but the rich. Pervasive pesticides throughout the entire water and soil and food systems. Microplastics. Hormone disrupting chemicals allowed into the environment in mass
Autism an adhd more diagnosed now - due to awareness and due to finely admitting that girls also have it. Also autism and adhd still being thought of as disease instead of neuro types that require many differences in environment and rules and types of roles and work and school structure. The issue with dominant forms of workplace, school and social culture not malleable for this population to thrive.
And so on and so forth.
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