Assisted reproductive technology: what are the cardiovascular risks for women?

ABSTRACT

Introduction

Infertility affects 15% of women of reproductive age in the United States. The use of assisted reproductive technology (ART) has been rising globally, as well as a growing recognition of reproductive factors that increase risk for cardiovascular disease (CVD).

Areas Covered

Women with infertility who use ART are more likely to have established CVD risk factors, such as obesity, dyslipidemia, hypertension, and diabetes. They are also more likely to experience adverse pregnancy outcomes, which are associated with both peripartum and long-term cardiovascular complications. ART may lead to increased cardiometabolic demands due to ovarian stimulation, pregnancy itself, and higher rates of multifetal gestation. Preeclampsia risk appears greater with frozen rather than fresh embryo transfers.

Expert Opinion

The use of ART and its association with long term CVD has not been well-studied. Future prospective and mechanistic studies investigating the association of ART and CVD risk may help determine causality. Nevertheless, CVD risk screening is critical pre-pregnancy and during pregnancy to reduce pregnancy complications that elevate future CVD risk. This also offers a window of opportunity to connect patients to longitudinal care for early management of cardiometabolic risk profile and initiation of preventive lifestyle and pharmacotherapy interventions tailored toward patient-specific risk factors.

KEYWORDS:

• Assisted reproductive technology (ART)
• infertility
• cardiovascular risk
• cardiovascular disease
• pregnancy

Article highlights

• Women with infertility who conceive with ART are more likely to have established CVD risk factors including obesity, dyslipidemia, hypertension, and diabetes.

• ART is associated with increased risk of adverse pregnancy outcomes, such as VTE, preeclampsia, and preterm delivery, which have been shown to increase peripartum and long-term CVD risk.

• There is no conclusive evidence for whether ART independently increases the long-term risk for incident CVD; however, risk for hypertensive disorder of pregnancy appears greater with frozen rather than fresh embryo transfer.

• CVD risk screening is essential for this population to prevent and manage pregnancy complications, as well as to connect patients to longitudinal care for management of CVD risk factors through lifestyle changes and pharmacotherapy.

• Future prospective studies evaluating ART with long-term follow-up for development of CVD are needed to help determine association and causality.

Declaration of interest

E Michos has served as a consultant for Amgen, Amarin, AstraZeneca, Bayer, Boehringer Ingelheim, Edwards Life Science, Esperion, Medtronic, Novartis, Novo Nordisk, Pfizer.

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/14779072.2023.2266355

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

E Michos is supported by the Amato Fund in Women’s Cardiovascular Health Research at Johns Hopkins University and American Heart Association Grant 946222. A Minhas is supported by the National Institutes of Health (KL2TR003099). V Baker is supported by funding from the National Institutes of Health (R01 HD100341). C Shufelt is supported by funding from the National Institutes of Health (R01 HD106096).