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Sixth grade academic achievement among children conceived with IVF: a population-based study in Texas, USA



To compare academic achievement in reading and mathematics at the end of sixth grade and progress from third to sixth grade by children conceived with in vitro fertilization (IVF) to those conceived naturally.


This was a retrospective population-based cohort study of IVF-conceived singleton and twin children who took the 3rd grade and 6th grade public school standardized reading and mathematics testing in Texas.


There were 6623 children with reading scores in both the third and sixth grades and 6374 children with mathematics scores in both the third and sixth grades. Mean (± SE) scaled test scores for IVF and control singleton children for reading were 1544.6 ± 3.4 and 1527.7 ± 1.9, respectively, in third grade and 1701.2 ± 3.6 and 1681.0 ± 2.0, respectively, in sixth grade; for mathematics, the scores were 1564.4 ± 3.7 and 1548.9 ± 2.1, respectively, in third grade and 1774.0 ± 4.2 and 1752.0 ± 2.3, respectively, in sixth grade. In multivariate models, singleton IVF children scored significantly higher than control children in reading and mathematics, averaging 17.7 ± 4.0 points and 20.1 ± 4.1 points higher, respectively, in reading in third and sixth grades and 17.8 ± 4.4 points and 25.0 ± 4.8 points higher, respectively, in mathematics in third and sixth grades.


Children conceived with IVF and aged 8–9 years and aged 10–12 years performed as well on third and sixth grade reading and mathematics assessments as their counterparts conceived naturally.

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Special acknowledgement to the Texas Department of State Health Services Center for Health Statistics Data Linking Team who linked SART CORS data to birth certificates, and to the TEA staff who assisted us in this study.

The authors thank the Society for Assisted Reproductive Technology and all of its members for providing clinical information to the Society for Assisted Reproductive Technology Clinic Outcome Reporting System database for use by patients and researchers. Without the efforts of their members, this research would not have been possible.

Availability of data

The data used in this analysis were obtained from private (SART CORS) and public (TEA test scores) sources, under data use agreements, and confidentiality pledges assuring that the data would not be shared or distributed, and therefore are not available to other investigators.


This project was supported by grant R01 HD084377 from the National Institute of Child Health and Human Development National Institutes of Health, USA (Barbara Luke, Principal Investigator). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child Health and Human Development, or the National Institutes of Health, nor any of the State Departments of Health which contributed data.

Author information

Authors and Affiliations



Drs. Luke and Brown had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Luke and Brown

Acquisition, analysis, or interpretation of data: all authors

Drafting of the manuscript: Luke, Brown

Critical revision of the manuscript for important intellectual content: all authors

Statistical analysis: Brown

Obtained funding: Luke, Brown

Administrative, technical, or material support: all authors

Supervision: Luke

Corresponding author

Correspondence to Barbara Luke.

Ethics declarations

Ethics approval

This study was approved by the Institutional Review Boards at Michigan State University, the University of Michigan, and each of the four study State Departments of Health.

Conflict of interest

Drs. Luke and Brown reported receiving grants from NIH during the conduct of the study. Ms. Forestieri, Dr. Yazdy, and Dr. Browne reported receiving NIH grant support from Michigan State University during the conduct of the study. Mr. Wantman reported receiving personal fees from SART, being a data vendor of SART, and maintaining the SART CORS database during the course of the study; and personal fees from NYU Fertility, MyEggBank, Prelude Fertility, Shady Grove Fertility, Northwell Health Fertility, and Mass General Fertility outside the submitted work. No other disclosures were reported.

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Luke, B., Brown, M.B., Ethen, M.K. et al. Sixth grade academic achievement among children conceived with IVF: a population-based study in Texas, USA. J Assist Reprod Genet 38, 1481–1492 (2021).

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  • IVF
  • Academic achievement
  • End-of-grade testing