Assisted Reproductive Technology for Adults With Congenital and Acquired Heart Disease

BACKGROUND: Assisted reproductive technology (ART) is increasingly used by individuals with cardiovascular disease (CVD) to achieve pregnancy. OBJECTIVES: The objective of the study was to compare adverse cardiovascular, obstetric, and neonatal events in individuals with CVD who conceived using ART vs age-matched controls who conceived spontaneously. METHODS: Retrospective analysis of the Standardized Outcomes in Reproductive Cardiovascular Care cohort from November 2011 to December 2024. Pregnancies conceived using ART were matched 2:1 with spontaneous conceptions in individuals with congenital or acquired CVD. An exploratory analysis for short-term safety and efficacy was performed in those who received ART at the primary center. RESULTS: The cohort included 100 pregnancies conceived with ART and 200 spontaneous pregnancies, followed for 1-year postpartum. There were no significant differences in congestive heart failure (4% vs 4%, P = 1.0) and sustained arrhythmia (9% vs 6%, P = 0.34). With respect to obstetric and neonatal outcomes, there was no difference in hypertensive disorders of pregnancy (21% vs 15%, P = 0.20), preterm birth (11% vs 13%, P = 0.85), birthweight (3.2 kg vs 3.1 kg, P = 0.40), or need for neonatal intensive unit admission (32% vs 22%, P = 0.13). In a subset of the population receiving ART at our institution (n = 41 subjects undergoing 57 in vitro fertilization cycles), there were 15 median oocytes per retrieval. There were 85 embryo transfers with an implantation rate of 56.2% and live birth rate of 57.7%. CONCLUSIONS: In individuals with CVD, pregnancy outcomes following ART were comparable to those with spontaneous conception, supporting the safety of ART in this population.