Cardiac Remodelling in ART-Conceived Singletons: A Prospective Cohort Study Comparing Biopsied and Non-Biopsied Embryos with Spontaneously Conceived Embryos

Objective: To compare cardiac remodelling in intracytoplasmic sperm injection (ICSI)-conceived singleton pregnancies (either biopsied or non-biopsied embryos) compared to spontaneously conceived (SC). Methods: This prospective cohort study comprised 113 pregnant women with biopsied ICSI (n=37), non-biopsied ICSI (n=37), and SC embryos (n=39). Women were recruited from Wael ElBanna Clinic and the National Research Center in Cairo, Egypt, between November 2021 and September 2023. Included women were: (1) adults, (2) pregnant with a singleton fetus, and (3) agreed to attend consecutive ultrasonographic investigations during their pregnancy period and agreed to sign an informed consent. The fetal ultrasonography evaluation involved estimating the fetal weight and conducting fetoplacental Doppler and fetal echocardiography. Mean and standard deviation (SD) were utilized to present numerical data, and the One-Way ANOVA test and post hoc test were used for analysis. Frequency (n) and percentage (%) were employed to present categorical data, which were analyzed using the Chi-square test. Multiple linear regression was performed on fetal echocardiographic data with adjustments for some variables (parity and birthweight centile) to compare pregnancy methods. Results: The cardiothoracic ratio and left ventricular free wall thickness were significantly higher in the biopsied ICSI group (p< 0.001). The right ventricular sphericity index was significantly lower in both ICSI groups, p< 0.001. After adjustment, the left ventricular sphericity index was higher in the non-biopsied ICSI group. In both ICSI groups, the septal wall thickness, right ventricular free wall thickness, Myocardial Performance Index, and the right atrial/heart ratio were significantly higher (p< 0.001, p< 0.05, respectively). The right ejection fraction and mitral E/A ratio were significantly lower in the non-biopsied ICSI group (p=0.032, 0.022, respectively). After adjustment, the same result was observed for the ejection fraction but not for the mitral E/A ratio. Conclusion: Cardiac remodelling was prominent among ICSI-conceived embryos compared to SC. However, these changes were subclinical, indicating the need for further investigation.