Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2023 Jul-Dec;21(10):663-673.
doi: 10.1080/14779072.2023.2266355. Epub 2023 Oct 26.

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

Carolyn Guan  1 , Carla Rodriguez  2 , Petal Elder-Odame  3 , Anum S Minhas  1 , Salman Zahid  4 , Valerie L Baker  5 , Chrisandra L Shufelt  6 , Erin D Michos  1
Affiliations
Review

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

Carolyn Guan et al. Expert Rev Cardiovasc Ther. 2023 Jul-Dec.

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); cardiovascular disease; cardiovascular risk; infertility; pregnancy.

PubMed Disclaimer

Conflict of interest statement

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.

Figures

Figure 1.
Figure 1.. Mechanistic diagram of the interrelationship of infertility, ART, CVD risk factors, and CVD.
Infertility and cardiometabolic risk factors are associated with use of ART, and the technology itself may elevate CV risk. While it is has been shown in literature that ART is associated with an elevated risk of pregnancy complications, it is unclear whether it is associated with increased incidence of CVD. Moreover, it is uncertain whether this association is causal or a result of confounding by known cardiovascular risk factors. Abbreviations: ART, assisted reproductive technology; CV, cardiovascular; CVD, cardiovascular disease; PCOS, polycystic ovary syndrome.
Figure 2.
Figure 2.. Multidisciplinary team approach for pre-conception, pregnancy, and longitudinal management.
Abbreviations: ART, assisted reproductive technology.
Figure 3:
Figure 3:. Proposed management algorithm of a patient using ART: prenatal, pregnancy, postpartum, and long-term risk reduction.
Abbreviations: APO, adverse pregnancy outcome; ART, assisted reproductive technology; ASCVD, atherosclerotic cardiovascular disease; CAC, coronary artery calcium; CVD, cardiovascular disease; PCOS, polycystic ovary syndrome.
See this image and copyright information in PMC

References

    1. Practice Committee of the American Society for Reproductive M. Diagnostic evaluation of the infertile female: a committee opinion. Fertil Steril. 2015;103(6):e44–50. - PubMed
    1. Wu P, Sharma GV, Mehta LS, et al. In-Hospital Complications in Pregnancies Conceived by Assisted Reproductive Technology. J Am Heart Assoc. 2022;11(5):e022658. - PMC - PubMed
    1. Brugo-Olmedo S, Chillik C, Kopelman S. Definition and causes of infertility. Reprod Biomed Online. 2001;2(1):41–53. - PubMed
    1. Carson SA, Kallen AN. Diagnosis and Management of Infertility: A Review. Jama. 2021;326(1):65–76. - PMC - PubMed
    1. Van Voorhis BJ. Clinical practice. In vitro fertilization. N Engl J Med. 2007;356(4):379–86. - PubMed