Assisted reproductive technology and the risk of pediatric cancer: A population based study and a systematic review and meta analysis

•A large cohort study did not show increased risk of pediatric cancer after ART.•Meta analysis of 13 cohort studies with a total of 450,183 women exposed to ART and 1, 912,192 unexposed controls did not reveal increased risk of pediatric cancers.•Based on large numbers of ART in general and IVF in particular are not associated with overall risk of pediatric cancer. There is controversy whether exposure to assisted reproductive technology (ART) is associated with increased risk of pediatric cancer. We aimed at calculating the overall risk of pediatric cancers after ART in a large cohort of exposed women; and to conduct a systematic review and meta- analysis of cohort studies examining overall risk of pediatric cancers after ART. All children born in Israel who were members of Maccabi Health Services (MHS) between 1999 and 2016 after ART, were linked to the Israeli Registry of Childhood Cancer (IGS) to identify those with cancer diagnosed before 16 years of age. In parallel we conducted a systematic review and meta-analysis of observational cohort studies with more than 5000 ART- exposed cases that measured pediatric cancer after ART. In the cohort study, the risk ratio for pediatric cancer after ART in general was 0.95 (95% CI, 0.76–1.19). The RR was 1.09 (95% CI, 0.79–1.48) for IVF treatments. Meta- analysis of 13 cohort studies with a total of 750,138 women exposed to ART (with 1152 pediatric cancers) and 214,008,000 unexposed controls (with 30,458 pediatric cancers) did not reveal increased risk for pediatric cancers (RR 0.99; 95% CI, 0.85–1.15). Based on very large numbers, ART in general, and IVF in particular, are not associated with overall increased risk of pediatric cancer.