Fetal cardiac function in ICSI-conceived pregnancies: a case–control study using MAPSE, TAPSE, and myocardial performance index

Background Assisted reproductive technologies (ART), particularly intracytoplasmic sperm injection (ICSI), have transformed infertility treatment. Growing evidence suggests that ART-conceived offspring may exhibit altered cardiovascular development. Sensitive echocardiographic parameters including mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), and the myocardial performance index (MPI) may detect early subclinical myocardial dysfunction. Objective To evaluate fetal cardiac function using MAPSE, TAPSE, and MPI in ICSI-conceived versus spontaneously conceived pregnancies, with adjustment for maternal confounders, and secondarily to compare fresh versus frozen embryo transfer subgroups. Methods This prospective case–control study included 200 singleton pregnancies at 20–27 weeks’ gestation: 100 conceived via ICSI and 100 spontaneously conceived controls frequency-matched for gestational age. Fetal cardiac function was assessed using M-mode and pulsed-wave Doppler to measure TAPSE, MAPSE, and left ventricular modified MPI. Analyses included multivariable linear regression, Bonferroni and Benjamini–Hochberg corrections for multiple comparisons and prespecified sensitivity analyses. Intra-observer reproducibility was evaluated in a 50-fetus subsample. Results Groups were comparable on all baseline characteristics except maternal age, which was higher in the ICSI group ( p < 0.001) and included as a covariate. MAPSE was lower in the ICSI group than in controls in the unadjusted (0.483 ± 0.087 versus 0.517 ± 0.110 cm; p = 0.018) and matched-pair (paired p = 0.007) analyses but was attenuated and non-significant after multivariable adjustment for maternal age and other covariates (adjusted p = 0.056) and was borderline under Bonferroni correction (adjusted p = 0.053); the MAPSE result is therefore interpreted as borderline rather than robust. MPI was higher in ICSI-conceived fetuses than in controls (0.716 ± 0.057 versus 0.690 ± 0.072; p = 0.006) and remained significant under all multiple-comparison corrections, multivariable adjustment, and matched-pair analysis. TAPSE did not differ between groups in any analysis ( p = 0.408). Intra-observer reproducibility was excellent (intraclass correlation coefficients ≥ 0.980). The observed MPI difference fell below the minimum detectable change for an individual fetus. Fresh and frozen embryo transfer subgroups did not differ on any cardiac parameter. Conclusion ICSI-conceived fetuses at mid-gestation demonstrate a modest elevation in the modified myocardial performance index, while longitudinal systolic function parameters show borderline or absent differences. These preliminary findings suggest subtle subclinical alteration in global myocardial performance; further longitudinal studies are warranted to determine their clinical significance.