Exploring the Association Between Medically Assisted Reproduction and Autism Spectrum Disorder: Clinical Correlations from a Retrospective Cohort

Background/Objectives: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by impairments in social interaction and communication, as well as by repetitive behaviors, with a rising global prevalence. Concurrently, the use of Assisted Reproductive Technologies (ART) has increased among couples experiencing infertility. This study aimed to compare the frequency of ART-conceived children between those diagnosed with ASD and those with other neurodevelopmental disorders (nASD), and to examine differences in prenatal, perinatal and medical histories of ART- and spontaneously (non-ART)-conceived children within an ASD group. Methods: We retrospectively analyzed data from 507 children with a neurodevelopmental disorders (NDDs) diagnosis, classified into ASD (n = 234) and nASD (n = 273) groups. Subsequent analyses focused on the ASD group, further divided into an ART and non-ART group according to the conception mode. Results: ART-conceived children were more frequent in the ASD group than in the nASD group. Moreover, within ASD, ART was significantly associated with potential risk factors such as twin pregnancy, cesarean delivery, low birth weight and parental age. Logistic Binary Regression confirmed these results, suggesting that ART co-occurs with a cluster of perinatal and familial risk factors. Conclusions: Our results indicate that ART is not an independent causal exposure; however, given the retrospective design and the absence of a general population control group, causal inference cannot be drawn. The observed association with ASD appears to be mediated by perinatal and parental variables. These findings underscore the importance of improving obstetric management and care, and ensuring early developmental monitoring for ART-conceived children.