Effect of Assisted Reproductive Technologies in Women With Cardiovascular Disease

BACKGROUND: Assisted reproductive technologies (ART) include medical interventions used to address infertility. As access to ART has expanded globally, more women with underlying cardiovascular disease (CVD) are pursuing these treatments. However, data regarding the safety profile and pregnancy outcomes of ART in women with CVD remain limited. In this study we evaluated whether ART is associated with adverse maternal cardiac, obstetric, and fetal and neonatal outcomes among women with CVD. METHODS: This was a retrospective case-control study of consecutive pregnancies achieved through ART, referred to a Canadian quaternary centre cardio-obstetrics program between 2021 and 2024. The ART cohort consisted of 66 pregnancies, which were matched 1:1 according to primary cardiac diagnosis with spontaneously conceived control pregnancies during the study period. RESULTS: The ART cohort included 34 women (51.5%) with acquired heart disease, 24 (36.4%) with congenital heart disease, 5 (7.6%) with acquired and congenital heart disease, and 3 (4.5%) with genetic syndromes with cardiac disease. Women in the ART cohort were older than control participants (mean age, 38.5 ± 5.6 vs 35.6 ± 4.7 years; P < 0.001). No cases of ovarian hyperstimulation syndrome or ART-related complications were observed. Women who conceived using ART had higher rates of cesarean delivery (68.2% vs 48.5% P = 0.031) and postpartum hemorrhage (13.6% vs 1.5%; P = 0.021). All other maternal cardiac, obstetric, and fetal and neonatal outcomes were comparable between groups. CONCLUSIONS: ART may be pursued with acceptable safety in women with low- to moderate-risk cardiac lesions or clinically stable CVD when managed in a specialized cardio-obstetric setting.