1. Language Development of Children Born Following Assisted Oocyte Activation Evelien D’haeseleer Evelien D’haeseleer, Frauke Vanden Meerschaut, Kim Bettens, Anke Luyten, Hannelore Gysels, Ylenia Thienpont, Griet De Witte, Björn Heindrynckx, Ann Oostra, Herbert Roeyers, Petra De Sutter, Kristiane Van Lierde Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Faculty of Medicine and Health Sciences

2. Background In Europe, 3.9% of national births are infants born after Assisted Reproduction Therapy (Nyboe Andersen et al., 2007) Neurodevelopmental outcome in ART –Effect of ART on the brain is not clear –Most controlled studies in IVF and ICSI show no increase neuromotor, cognitive, language and behavioral problems (Middelburg et al., 2008) –Language development is rarely studied in a detailed sense. New and more invasive techniques –ICSI combined with different activating agents –Absence of intensive follow-up programs Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Background

3. Assisted Oocyte Activation (AOA) Intracytoplasmic sperm injection (ICSI) –An in vitro fertilization (IVF) procedure in which a single sperm is injected directly into the egg. AOA –Highly specialized fertilization technique –ICSI + injection of calcium chloride (CaCl 2 ) followed by a twofold calcium ionophore exposure of the injected oocyte Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Assisted Oocyte Activation www.ivf.com No evidence regarding its safety and efficacy! No follow-up information!

4. Purpose The main purpose of this study is to investigate the expressive and perceptive language development of 3-10-year-old children born following AOA. Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Purpose Secondly, a comparison is made between the language scores of singletons and twins.

5. Methods Participants 20 children older than 3y born following AOA –Sex: –Sex:6 boys, 14 girls –Twins: –Twins:11 singletons, 9 twins –age: –age: Mean: 5;4 y (SD:1;8y) Range: 3;1-10;4y –Pregnancy duration: –Pregnancy duration:Mean: 38.2 w (SD: 2,3) Range: 32-41w Premature: 2 children (twin) –Birth weight: –Birth weight:Mean: 3187.5 g (SD:712)Range: 1640-4140g Low birth weight: 4 children (twins) Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Methods

6. Assessment of cognitive development Children < 7 y  Primary Scale of Intelligence (WPPSI-III-NL) Children > 7 y  Wechsler Intelligence Scale for Children (WISC-III-NL) Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Methods Full Scale Intelligence QuotientFSIQ Verbal Intelligence Quotient VIQ Performance Intelligence Quotient PIQ

7. Assessment of language development Children < 5 y  Reynell Developmental Scales Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Methods Total Language score: Language Comprehension Scale Language Production Scale -Vocabulary -Language Content -Spontaneous Language Production

8. Children > 5 y  Clinical Evaluation of Language Fundamentals, CELF-IV-NL Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Methods Indices: Core Language Index Receptive Language Index Expressive Language Index Subtests: - Concepts and Following Directions - Word Structure (<9y) - Recalling Sentences - Formulated Sentences - Word Definitions (> 9y) - Word Classes < 9y - Word Classes > 9y - Sentence Structure (<9y) - Expressive Vocabulary - Semantic Relationships (>9y)

9. Results Cognitive Development Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Results nMeanMinMaxSD VIQ20103.17712914.0 PIQ20106.57414216.4 FSIQ20105.88514414.9 Normal intelligence scores

10. Language Development General language –Clinical zone for language impairment (< pc 5): none –Subclinical zone (< pc10): 1 child No significant differences between expressive and receptive language Subtests –< pc 10 for two or more subtest: 4 children (two twins) Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Results Standard scores (percentile rank)nMeanMinMaxSD Total Score/Core Language2056.89.19933.6 Expressive Language2055.37.19935.0 Receptive Language2055.03.69938.9

11. Comparison between singletons and twins and between two age groups ANOVA No interaction effect youngerolder 5 yearsNo differences between the results of the children younger and older than 5 years SingletonstwinsSingletons scored significantly better compared to the twins for –Receptive language skills (p= 0.007) –Expressive language skills (p=0.041) Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Results

12. Discussion & Conclusion Language Development First study investigating the outcome of AOA children The general language scores of the AOA children in this study are located within the normal ranges. –One child (twin) was located within the subclinical zone of language impairment (pc 9)  follow-up 20% of the children scored below pc 10 on two or more subtests of the language battery. Cognitive development of all the children was normal Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Discussion & Conclusion

13. Comparison singletons and twins Singletons scored significantly better for expressive and receptive language skills Gucuyener et al. (2011): Language delay of 3 months in IVF twins compared to IVF singletons Possible explanations: obstetricperinatal complications –More obstetric and perinatal complications in twins family interaction –Different patterns in family interaction cryptophasia –Specific language characteristics: cryptophasia pretermlower birth weights –More preterm births and lower birth weights Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Discussion & Conclusion

14. Limitations Absence of a control group of spontaneously conceived children High response rate small absolute number of children included Long-term follow-up in the future of these children is necessary Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Discussion & Conclusion

15. Thank you very much for your attention Evelien D’haeseleer, Frauke Vanden Meerschaut, Kim Bettens, Anke Luyten, Hannelore Gysels, Ylenia Thienpont, Griet De Witte, Björn Heindrynckx, Ann Oostra, Herbert Roeyers, Petra De Sutter, Kristiane Van Lierde Ghent University, Belgium Department of Speech, Language and Hearing Sciences 29th World Congres of the IALP – August 25-29, 2013 Discussion & Conclusion