Association between assisted reproductive technologies and offspring allergic rhinitis: a systematic review and meta-analysis

To evaluate the association between assisted reproductive technologies (ART) and the risk of allergic rhinitis (AR) in offspring through a systematic review and exploratory meta-analysis. This study followed PRISMA guidelines and was registered in PROSPERO (ID: CRD420251248853). PubMed, Embase, and Web of Science were searched from database inception to December 31, 2025, for observational studies assessing ART exposure and AR outcomes in offspring. Study quality was evaluated using the Newcastle–Ottawa Scale (NOS) for cohort studies and the AXIS tool for cross-sectional studies. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using Chi2 and I2 statistics. Subgroup analyses were conducted by allergic phenotype, geographic region, and ART procedure period. Sensitivity analyses were performed using a leave-one-out approach. Six observational studies involving 635,621 offspring were included, comprising 28,540 ART-conceived children and 607,081 naturally conceived controls. Methodological quality was moderate to high. The pooled analysis showed no statistically significant association between ART and AR risk (RR 0.82, 95% CI 0.50–1.36). Subgroup analyses by allergic phenotype, geographic region, ART procedure period and outcome assessment method similarly revealed no significant differences. Sensitivity analyses confirmed that no single study materially influenced the pooled estimate, although the high heterogeneity (I2 = 98.6%) limits the interpretability of the pooled effect size. Current evidence does not support a significant association between ART and the risk of AR in offspring. Although substantial methodological heterogeneity and a limited number of studies warrant cautious interpretation, the available data do not support a clear or consistent association between ART and offspring AR risk. Further large-scale studies with detailed ART stratification and long-term follow-up are needed to clarify potential subtle immunological effects.