Effect of pregnancy planning and fertility treatment on cognitive outcomes in children at ages 3 and 5: longitudinal cohort study Effects of fertility education on knowledge, desires and anxiety among the reproductive-aged population: findings from a randomized controlled trial Development of children born after ovarian superovulation induced by long-acting gonadotropin-releasing hormone agonist and menotropins, and by in vitro fertilization. The Groningen assisted reproductive technologies cohort study: developmental status and behavior at 2 years. Cognitive-Behavioral Therapy for Idiopathic Infertile Couples A prospective longitudinal study of the physical, psychomotor, and intellectual development of singleton children up to 5 years who were conceived by intracytoplasmic sperm injection compared with children conceived spontaneously and by in vitro fertilization. The impact of group psychological interventions on distress in infertile women. Mental, psychomotor, neurologic, and behavioral outcomes of 2-year-old children born after preimplantation genetic screening: follow-up of a randomized controlled trial. Evaluation of a group programme of mindfulness-based cognitive therapy for women with fertility problems The effect of preimplantation genetic screening on neurological, cognitive and behavioural development in 4-year-old children: follow-up of a RCT. The development of cognitive and academic abilities: growth curves from an early childhood educational experiment. Increasing fertility knowledge and awareness by tailored education: a randomized controlled trial. Fertility treatment and risk of childhood and adolescent mental disorders: register based cohort study Effect of 2 years of high-dose growth hormone therapy on cognitive and psychosocial development in short children born small for gestational age. Web-based treatment for infertility-related psychological distress Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial Incorporating spirituality in psychosocial group intervention for women undergoing in vitro fertilization: a prospective randomized controlled study.
Objective To investigate how pregnancy planning , time to conception , and infertility treatment influence cognitive development at ages 3 and 5 . Design Prospect i ve population based cohort study . Setting Millennium Cohort Study in the United Kingdom . Participants 18 818 children recruited at 9 months and followed up at 3 and 5 years . 11 790 singletons with available data on pregnancy , cognitive outcomes , and confounders were included in analyses at age 3 and 12 136 at age 5 . Exposure measures Mothers reported whether the pregnancy was planned , and their feelings when first pregnant ; those in whom the pregnancy was planned provided time to conception , and details of any assisted reproductive technologies . The population was divided into “ unplanned ” ( unplanned and unhappy ) , “ mistimed ” ( unplanned but happy ) , “ planned ” ( planned , time to conception < 12 months ) , “ subfertile ” ( planned , time to conception ≥12 months ) , “ induced ovulation ” ( received clomiphene citrate ) , and “ assisted reproduction ” ( in vitro fertilisation or intracytoplasmic sperm injection ) . The “ planned ” group was the comparison group in all analyses . Outcome measures Three components of the British Ability Scales ( BAS II ) . Naming vocabulary assessed verbal ability at age 3 ; this test was repeated at age 5 with the picture similarities and pattern construction subscales , which measure non-verbal and spatial abilities . Results In unadjusted analyses , the scores on all scales in children from unplanned pregnancies were significantly lower than in those from planned pregnancies — for example , the difference in mean verbal ability score at age 3 was −4.8 ( 95 % confidence interval −6.0 to −3.7 ; P<0.05 ) , equivalent to an average delay of four months . After adjustment for sociodemographic factors these differences were attenuated : −0.3 ( −1.3 to 0.7 ) , equivalent to no delay . Children born after assisted reproduction performed consistently better in verbal ability tests ( 3.8 ( −0.2 to 7.9 ) at age 3 and 3.5 ( 0.2 to 6.8 ) at age 5 ) , which suggests that on average these children are three to four months ahead ; this difference did not completely disappear with adjustment for confounders . Children born after infertility treatment had lower mean scores in non-verbal tests ( −1.2 ( −4.1 to 1.6 ) after assisted reproduction and −1.5 ( −3.5 to 0.4 ) after induced ovulation ) and in spatial ability tests ( −2.7 ( −6.9 to 1.6 ) after assisted reproduction ) , though the differences were not significant . Conclusions Pregnancy planning , subfertility , or assisted reproduction do not adversely affect children ’s cognitive development at age 3 or 5 . The differences observed in the unadjusted analyses are almost entirely explained by marked inequalities in socioeconomic circumstances between the groups STUDY QUESTION What are the effects of fertility education on knowledge , childbearing desires and anxiety ? SUMMARY ANSWER Providing fertility information contributed to greater knowledge , but increased anxiety . WHAT IS KNOWN ALREADY Past studies have found that exposure to educational material improved fertility awareness and changed desires toward childbearing and its timing . Existing educational websites with evidence -based medical information provided in a non-judgmental manner have received favorable responses from reproductive-aged men and women . STUDY DESIGN , SIZE , DURATION This three-armed ( one intervention and two control groups ) , r and omized controlled trial was conducted using online social research panels ( SRPs ) in Japan in January 2015 . PARTICIPANTS / MATERIAL S , SETTING , METHODS A total of 1455 participants ( 726 men and 729 women ) between 20 and 39 years of age who hoped to have ( more ) children in the future were block-r and omized and exposed to one of three information brochures : fertility education ( intervention group ) , intake of folic acid during pregnancy ( control group 1 ) or governmental financial support for pregnancy and childbirth ( control group 2 ) . Fertility knowledge was measured with the Japanese version of the Cardiff Fertility Knowledge Scale ( CFKS-J ) . Knowledge , child-number and child-timing desires , subjective anxiety ( i.e. whether participants felt anxiety [ primary outcome ] ) , and scores on the State-Trait Anxiety Inventory were assessed immediately after exposure . Non-inferiority comparisons were performed on subjective anxiety with non-inferiority declared if the upper limit of the two-sided 95 % confidence interval ( CI ) for risk difference did not exceed a margin of 0.15 . This test for non-inferiority was only performed for subjective anxiety ; all the other variables were tests of superiority . MAIN RESULTS AND THE ROLE OF CHANCE Posttest scores on the CFKS-J ( mean , SD ) were higher in the intervention group than that of the control groups : intervention versus Control 1 and versus Control 2 : 52.8 ( 28.8 ) versus 40.9 ( 26.2 ) ( P < 0.001 ) versus 45.1 ( 27.1 ) ( P = 0.003 ) among men and 64.6 ( 26.0 ) versus 50.8 ( 26.9 ) ( P < 0.001 ) versus 53.0 ( 26.4 ) ( P < 0.001 ) among women . The percentage of participants who felt subjective anxiety after exposure to the intervention brochure was significantly higher than that of the control groups : intervention versus Control 1 and versus Control 2 : 32.6 versus 17.8 % ( risk difference [ RD ] = 0.149 , 95 % CI : 0.073–0.225 ) versus 14.5 % ( RD = 0.182 , 95 % CI : 0.108–0.256 ) among men , and 50.2 versus 26.3 % ( RD = 0.239 , 95 % CI : 0.155–0.322 ) versus 14.0 % ( RD = 0.362 , 95 % CI : 0.286–0.439 ) among women . Non-inferiority of the intervention was inconclusive ( i.e. the CI included 0.15 ) among men whereas inferiority was declared among women . The incidence of anxiety was higher in the intervention group than that of the control groups especially among men aged 30 and older and among women aged 25 and older . No difference existed in childbearing desires between groups after exposure . LIMITATIONS , REASONS FOR CAUTION The possibility of selection bias associated with the use of SRPs ( higher socioeconomic status and education ) and volunteer bias toward those more interested in fertility may limit the generalizability of these findings . WIDER IMPLICATION S OF THE FINDINGS In addition to education targeting a younger generation , psychological approaches are needed to alleviate possible anxiety caused by fertility information . STUDY FUNDING /COMPETING INTEREST(S ) This study was funded by National Center for Child Health and Development , Seiiku Medical Study Grant ( 24 - 6 ) , the Daiwa Foundation Small Grants and Grant-in-Aid for JSPS Fellows ( 26 - 1591 ) . No competing interest declared . TRIAL REGISTRATION NUMBER UMIN Clinical Trials Registry . Trial registration number , 000016168 . TRIAL REGISTRATION DATE 13 January 2015 . DATE OF FIRST PATIENT 'S ENROLMENT 15 January 2015 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 evaluate whether children 's  cognitive and psychomotor development and behavior at 2 years are affected by ovarian hyperstimulation and the IVF laboratory procedures or subfertility . DESIGN Prospect i ve longitudinal cohort study . SETTING University Medical Center Groningen , the Netherl and s. PATIENT(S ) Singletons born after controlled ovarian hyperstimulation (COH)-IVF ( n=66 ) and modified natural cycle-IVF ( n=56 ) , singletons born to subfertile couples who conceived naturally ( subfertile-naturally conceived , n=87 ) , and a reference group of 101 2-year-old singletons born to fertile couples . INTERVENTION(S ) None . MAIN OUTCOME MEASURE(S ) Bayley Scales of Infant Development and Achenbach Child Behavior Checklist . RESULT ( S ) Mental and psychomotor development and behavioral outcome in COH-IVF , modified natural cycle-IVF , and subfertile-natural cycle groups was not different . Developmental outcome and behavior of the subfertile groups were largely similar to those of the fertile reference group . Nevertheless , the subfertile groups scored higher on the scale of anxious-depressed behavior than the reference group . CONCLUSION ( S ) This present relatively small study found no differences in cognitive and psychomotor development and behavior at 2 years in children born after COH-IVF or modified natural cycle-IVF or naturally conceived children of subfertile parents . Replication of the study is needed before firm conclusions can be drawn . Furthermore , long-term follow-up is needed to confirm these findings in older children Background : The purpose of this pilot study was to evaluate the impact of a 6-month cognitive-behavioral therapy for infertile couples . Methods : Seventeen idiopathic infertile couples participated in a therapy program comprised of modules to behaviorally optimize the chance of conception , improve sexual functioning and satisfaction , reduce thoughts of helplessness and , if necessary , improve marital communication skills . Pre- to posttreatment changes in the therapy group were compared to changes in two control groups . Results : The therapy group showed an improvement in sperm concentration , a reduction in thoughts of helplessness and a decrease in marital distress . By the end of therapy participants practice d timed intercourse more reliably and reported unchanged sexual pleasure and satisfaction during the nonfertile period of the menstrual cycle . At the 6-month follow-up , problem-focused thoughts had decreased . The live birth rate was higher in the therapy group than in epidemiological sample s. Conclusion : Preliminary data suggest that cognitive-behavioral treatment may be an effective approach for the treatment of infertility 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 Infertile women express higher levels of distress than fertile women , with distress peaking between the 2nd and 3rd year . The purpose of this study was to determine whether group psychological interventions could prevent this surge . One hundred eighty-four women who had been trying to conceive between 1 and 2 years were r and omized into either a cognitive-behavioral group , a support group , or a control group . All experimental participants attended a 10-session group program . Participants completed psychological question naires at intake and again at 6 and 12 months . Substantial attrition occurred , particularly in the control group . The cognitive-behavioral and support participants experienced significant psychological improvement at 6 and 12 months compared with the control participants , with the cognitive-behavioral participants experiencing the greatest positive change OBJECTIVE To evaluate the effect of preimplantation genetic screening ( PGS ) on neurodevelopmental outcomes in children . DESIGN Prospect i ve , assessor-blinded , follow-up study of children born to women r and omly assigned to in vitro fertilization or intracytoplasmic sperm injection ( IVF/ICSI ) with or without PGS .  SETTING University Medical Center , Groningen , and Academic Medical Center , Amsterdam , the Netherl and s. PATIENT(S ) Fifty-four PGS children and 77 controls .  INTERVENTION(S ) PGS . MAIN OUTCOME MEASURE(S ) Mental , psychomotor , neurologic , and behavioral outcomes in 2-year-old children  as measured with the Bayley Scales of Infant Development , the Hempel neurologic examination , and the Child Behavior Check List . RESULT ( S ) The mental , psychomotor , and behavioral outcomes at 2 years in children born after IVF with and without PGS were similar overall . The PGS children showed lower neurologic optimality scores than the control children . Scores on all tests were within the normal range . CONCLUSION ( S ) Conception with PGS does not seem to be associated with impaired mental , psychomotor , or behavioral outcomes by age 2 . However , the lower neurologic optimality scores found in the PGS children may signal less favorable long-term neurologic outcomes in PGS children . Our findings stress the need for safety evaluations with new assisted reproductive techniques before large-scale implementation Mindfulness-based cognitive therapy ( MBCT ) has proved helpful for a number of health-related conditions but there is relatively little published literature about its use with fertility problems . The aim of this paper is to describe a pilot group programme adopted by a Clinical Health Psychology department , and to present findings from the routine outcomes data gathered by the service , evaluating its effectiveness . Data from nine women with fertility problems that took part in the programme were analysed . They completed measures of wellbeing and psychological distress before and after the treatment . The results showed clinical ly significant improvements in participants ’ wellbeing scores and psychological distress . It was a limitation of the study that the impact of concurrent treatments could not be assessed and so could also have contributed to this outcome in half of the cases . Nevertheless , these results suggest that MBCT may be a helpful treatment for women presenting with fertility-related distress STUDY QUESTION Does embryo biopsy inherent to preimplantation genetic screening ( PGS ) affect neurological , cognitive and behavioural development  of 4-year-old children ? SUMMARY ANSWER PGS does not seem to affect neurological , cognitive and behavioural development of 4-year-old singletons ; however , our data suggest that it may be associated with altered neurodevelopment in twins . WHAT IS KNOWN ALREADY Evidence concerning the safety of PGS on neurodevelopmental outcome in offspring is scarce . The present study provides information on neurodevelopmental , cognitive and behavioural outcome of 4-year-old PGS offspring . STUDY DESIGN , SIZE , DURATION A prospect i ve , assessor-blinded follow-up study of children born to women who participated in a multi-centre RCT on the effect of IVF with or without PGS .  PARTICIPANTS / MATERIAL S , SETTING , METHODS At 4 years , 49 children ( 31 singletons , 9 sets of twins ) born following IVF with PGS and 64 children ( 42 singletons , 11 sets of twins ) born following IVF without PGS ( controls ) were assessed ( post-natal attrition 18 % ) . Neurological development was evaluated with the st and ardized , age-specific and sensitive neurological examination according to Hempel , result ing in a neurological optimality score ( NOS ) , a fluency score and the rate of adverse neurological outcome . Primary outcome was the fluency score , as fluency of movements is easily reduced by subtle dysfunction of the brain . Cognitive development was evaluated with the Kaufman Assessment Battery for Children ; behavioural development was evaluated with the Child Behavior Checklist . The effect of PGS was analysed with a mixed effects model . MAIN RESULTS AND THE ROLE OF CHANCE Based on the intention to treat analysis , neurodevelopmental outcome of PGS children was similar to that of controls . However , additional analyses indicated that PGS affected neurodevelopmental outcome of twins in a different way than that of singletons . The fluency score of singletons born following PGS was similar to that of control singletons [ mean values , 95 % confidence intervals ( CIs ) : 12.2 ( 11.5;12.8 ) and 12.2 ( 11.6;12.8 ) ] , respectively , P = 0.977 ) that was also true for the other neurodevelopmental parameters . The fluency score of PGS twins was significantly lower than that of control twins [ mean values , 95 % CIs : 10.6 ( 9.8;11.3 ) and 12.3 ( 11.5;13.1 ) ] , respectively , P = 0.001 ) ; the same was true for the NOS . In addition , PGS in twins was associated with a higher sequential intelligence quotient score . On the other h and , other neurodevelopmental parameters were similar for PGS twins and control twins . Post hoc sample size calculation for the primary outcome parameter , the fluency score , indicated that the study groups , including the subgroups of singletons and twins , were adequately powered . LIMITATIONS , REASONS FOR CAUTION We assessed singletons and twins who contributed to the generalizability of the study . A limitation of our study is the relative small size of our study groups and the selective dropout in both groups ( dropouts PGS group : higher gestational age ; control group : less well-educated parents ) . These preclude the conclusion that PGS per se is not associated with neurodevelopmental , cognitive and behavioural problems in singletons and the conclusion that PGS is associated with altered neurodevelopmental outcome in twins . WIDER IMPLICATION S OF THE FINDINGS The need for careful long-term monitoring of children born following  embryo biopsy  remains , as it is still applied in the form of PGD and it is still unknown whether embryo biopsy affects long-term neurodevelopmental outcome In the Abecedarian Project , a prospect i ve r and omized trial , the effects of early educational intervention on patterns of cognitive and academic development among poor , minority children were examined . Participants in the follow-up were 104 of the original 111 participants in the study ( 98 % African American ) .  Early treatment was full-time , high- quality , educational child care from infancy to age 5 .  Cognitive test scores collected between the ages of 3 and 21 years and academic test scores from 8 to 21 years were analyzed . Treated children , on average , attained higher scores on both cognitive and academic tests , with moderate to large treatment effect sizes observed through age 21 . Preschool cognitive gains accounted for a substantial portion of treatment differences in the development of reading and math skills . Intensive early childhood education can have long-lasting effects on cognitive and academic development Women of reproductive age have insufficient fertility knowledge and awareness . Reproductive lifespan and assisted reproduction are the primary areas in which awareness is lacking . Relatively simple interventions can be used to increase knowledge among university students ; however , no intervention has been tested to date in a population with more varied education levels . The aim of this study was to evaluate which intervention most improved fertility knowledge in women attending a fertility centre for oocyte donation . A r and omized controlled trial was conducted with three intervention groups : tailored , untailored and control . A question naire was administered on the day of the first consultation , and again at the oocyte retrieval . Two hundred and one women were enrolled and completed the pre-test , 109 started the cycle and 90 completed the post-test . The effect of the intervention was measured as the difference between the groups in their score from the pre-test to the post test . Only the tailored group showed a significant increase ( + 2.5 ; 95 % CI [ 1.8 , 3.3 ] ; P = 0.001 ) . Information relating to a woman 's most fertile age and limits for childbearing were the most useful . Tailored oral education , therefore , increases fertility knowledge in young women , particularly in relation to their fertility lifespan Objective To assess the mental health of children born after fertility treatment  by comparing their risk of mental disorders with that of spontaneously conceived children . Design Prospect i ve register based cohort study . Setting Nationwide register based information from Danish National Health Registers cross linked by a unique personal identification number assigned to all citizens in Denmark . Participants All children born in Denmark in 1995 - 2003 with follow-up in 2012 when the children were aged 8 - 17 ; 33 139 children were conceived after fertility treatment and 555 828 children were born after spontaneous conception .  Main outcome measures Absolute risks and hazard ratios for overall and specific mental disorders estimated with adjustment for potential confounding variables . Estimated association between the risk of mental disorders and subtypes of procedures , hormone treatments , gamete types , and cause of infertility . Results The risk of mental disorders in children born after in vitro fertilisation or intracytoplasmic sperm injection was low , and was no higher than in spontaneously conceived children , except for a borderline significant increased risk of tic disorders ( hazard ratio 1.40 , 95 % confidence interval 1.01 to 1.95 ; absolute risk 0.3 % ) . In contrast , children born after ovulation induction with or without insemination had low but significantly increased risks of any mental disorder ( 1.20 , 1.11 to 1.31 ; absolute risk 4.1 % ) , autism spectrum disorders ( 1.20 , 1.05 to 1.37 ; 1.5 % ) , hyperkinetic disorders ( 1.23 , 1.08 to 1.40 ; 1.7 % ) , conduct , emotional , or social disorder ( 1.21 , 1.02 to 1.45 ; 0.8 % ) , and tic disorders ( 1.51 , 1.16 to 1.96 ; 0.4 % ) . There was no risk systematic ally related to any specific type of hormone drug treatment . Conclusions There was a small increase in the incidence of mental disorders in children born after ovulation induction/intrauterine insemination . Children born after in vitro fertilisation/intracytoplasmic sperm injection were found to have overall risk comparable with children conceived spontaneously OBJECTIVE AND DESIGN Children born small for gestational age ( SGA ) are not only at risk for short stature , but also for neurodevelopmental and behavioral problems . In this study , we analyzed the effects of high-dose GH therapy on cognitive development and psychosocial functioning in 34 prepubertal ( 3 - 8 years ) short SGA children , equally r and omized into a GH-treated group ( TRG ) and an untreated group ( UTRG ) . METHODS At start and after 2 years , children underwent st and ardized tests measuring the intellectual abilities ( Wechsler Preschool and Primary Scale of Intelligence-Revised , or Wechsler Intelligence Scale for Children-Revised ) ; their parents completed a st and ardized question naire evaluating psychosocial functioning ( Child Behavior Checklist ; CBCL ) . RESULTS At start , total IQ scores were significantly ( P < 0.05 ) lower in the SGA group than in the general population : 32 % of the SGA patients had scores below 85 . After 2 years , IQ scores remained unchanged in the TRG , but increased significantly ( P < 0.05 ) in the UTRG . After exclusion of children with developmental problems , however , no significant changes in IQ scores occurred in the UTRG as well as the TRG . At baseline , 24 % ( 8/34 ) children had problematic CBCL total problems scores , equally distributed among the two groups ; no significant changes in the different subscale scores occurred after 2 years . CONCLUSION No beneficial effect of 2 years of GH therapy on cognitive and behavioral profile could be observed in a cohort of rather young short SGA children presenting a variable degree of developmental delay and behavioral problems . Subsequent follow-up could reveal potential long-term effects of GH therapy on development and behavior Infertility has been associated with stigma and negative psychosocial functioning . However , only a small proportion of this population actually receives care . Fertility patients predominantly use the Internet for information gathering , social support , and assistance with decision-making ; yet , available web re sources are unreliable sources of mental health care . Web-based alternatives also have the potential to assist with intervention access difficulties and may be of significant lower cost . This study evaluated the efficacy of a web-based approach to providing a cognitive behavioral intervention with 31 infertile women seeking medical reproductive technologies . Following r and omized assignment , participants using the web-based intervention were compared with those in a wait-list control condition on general and infertility-related psychological stress measures . Results were mixed regarding intervention efficacy . Significant declines in general stress were evidence d in the experimental group compared with a wait-list control group . However , website access did not result in statistically significant improvements on a measure of infertility-specific stress . These findings add to the literature on psychological interventions for women experiencing fertility problems . Moreover , despite the widespread use of the Internet by this population , the present study is one of the first to investigate the usefulness of the Internet to attenuate stress in this population . Preliminary results suggest general stress may be significantly reduced in infertile women using an online cognitive behavioral approach Background Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits . There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness . We design ed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive , academic and behavioral outcomes . Methods This parallel group r and omised study was carried out in Kampala City , Ug and a between February 2008 and October 2010 . Sixty-one Ug and an children aged 5 to 12 years with severe malaria were assessed for cognition ( using the Kaufman Assessment Battery for Children , second edition and the Test of Variables of Attention ) , academic skills ( Wide Range Achievement Test , third edition ) and psychopathologic behaviour ( Child Behaviour Checklist ) three months after an episode of severe malaria . Twenty-eight were r and omised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group . Post-intervention assessment s were done a month after conclusion of the intervention . Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment , adjusting for age , sex , weight for age z score , quality of the home environment , time between admission and post-intervention testing and pre-intervention score . The primary outcome was improvement in attention scores for the intervention group . This trial is registered with Current Controlled Trials , number IS RCT N53183087 . Results Significant intervention effects were observed in the intervention group for learning mean score ( SE ) , [ 93.89 ( 4.00 ) vs 106.38 ( 4.32 ) , P = 0.04 ] but for working memory the intervention group performed poorly [ 27.42 ( 0.66 ) vs 25.34 ( 0.73 ) , P = 0.04 ] . No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures . Conclusions In this pilot study , our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour . Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained . Trial registration IS RCT N : IS RCT OBJECTIVES This study examined the efficacy of a group intervention , the Integrative Body-Mind-Spirit ( I-BMS ) intervention , which aims at improving the psychosocial and spiritual well-being of Chinese women undergoing their first IVF treatment cycle . DESIGN The I-BMS intervention facilitates the search of meaning of life in the context of family and childbearing , as well as the letting go of high IVF expectations . A r and omized controlled study of 339 women undergoing first IVF treatment cycle in a local Hong Kong hospital was conducted ( intervention : n= 172 ; no-intervention control : n= 167 ) . METHODS Assessment s of anxiety , perceived importance of childbearing , and spiritual well-being were made at r and omization ( T(0 ) ) , on the day starting ovarian stimulations ( T(1 ) ) , and on the day undertaking embryo transfer ( T(2 ) ) . RESULTS Comparing T(0 ) and T(2 ) , interaction analyses showed women who had received the intervention reported lower levels of physical distress , anxiety , and disorientation . They reported being more tranquil and satisfied with their marriage , and saw childbearing as less important compared to women in the control group . CONCLUSIONS These findings suggest that I-BMS intervention was successful at improving the psychosocial and spiritual well-being of women undergoing their first IVF treatment cycle . This study highlights the importance of providing integrative fertility treatment that incorporates psychosocial and spiritual dimensions
SUMMARY ANSWER The available high- quality evidence indicates that specific treatments may give rise to different effects on cognitive development , with certain treatments , including ICSI , associated with cognitive impairment .
STUDY QUESTION Does  fertility treatment  influence cognitive ability in school aged children , and does the impact vary with the type of treatment ?
WHAT IS KNOWN ALREADY Previous review s of the literature concerning cognitive outcomes among children conceived with medical assistance have concluded that study findings are generally ' reassuring ' , but limited attention has been paid to the quality of this research .
In addition , no review has separately assessed the range of treatment modalities available , which vary in invasiveness , and thus , potentially , in their effects on developmental outcomes .