CCS often wish to have biological children yet harbour concerns about fertility impairment, pregnancy risks and the general health risks of prospective offspring. To clarify these concerns, health outcomes in survivor offspring born following ART (n = 74, 4.5%) or after spontaneous conception (n = 1585) were assessed in our European offspring study by descriptive and bivariate analysis. Outcomes were compared to a sibling offspring cohort (n = 387) in a 4:1 matched-pair analysis (n = 1681). (i) Survivors were more likely to employ ART than their siblings (4.5% vs. 3.7%, p = 0.501). Successful pregnancies were achieved after a median of one cycle with, most commonly, intracytoplasmic sperm injection (ICSI) using non-cryopreserved oocytes/sperm. (ii) Multiple-sibling births (p < 0.001, 29.7% vs. 2.5%), low birth weight (p < 0.001; OR = 3.035, 95%-CI = 1.615−5.706), and preterm birth (p < 0.001; OR = 2.499, 95%-CI = 1.401−4.459) occurred significantly more often in survivor offspring following ART utilisation than in spontaneously conceived children. ART did not increase the prevalence of childhood cancer, congenital malformations or heart defects. (iii) These outcomes had similar prevalences in the sibling population. In our explorative study, we could not detect an influence on health outcomes when known confounders, such as multiple births, were taken into account.

Berlin Institute of Health 10178 Berlin Germany

Charité Universitätsmedizin Berlin Germany Corporate Member of Freie Universität Berlin Humboldt Universität zu Berlin Berlin Institute of Health Department of Paediatric Oncology Haematology and Stem Cell Transplantation 13353 Berlin Germany

Department of Health Sciences and Medicine University of Lucerne 6002 Luzern Switzerland

Department of Obstetrics and Gynaecology Erlangen University Hospital Friedrich Alexander University of Erlangen Nuremberg 91054 Erlangen Germany

Department of Oncology Hematolgy and Transplantology Medical University Wroclaw 50 367 Wrocław Poland

Department of Paediatric Oncology Masaryk University University Hospital Brno 61137 Brno Czech Republic

Department of Pediatric Hematology and Oncology 2nd Faculty of Medicine Charles University and University Hospital Motol 15006 Prague Czech Republic

Medical University Graz 8036 Graz Austria

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