Fertility Treatments-Is It A Risk Factor For Long-Term Maternal Cardiovascular Morbidity?

To investigate whether patients who undergo fertility treatments (ovulation induction [OI] or in vitro fertilization [IVF]) have an increased risk for future maternal cardiovascular morbidity. A population-based study compared the incidence of long-term cardiovascular morbidity in a cohort of women with and without a previous exposure to fertility treatments. Deliveries occurred during a 25 years period, since the year 1988, with a mean follow-up duration of 11.2 years. Women with known cardiovascular disease and congenital cardiovascular malformations diagnosed prior to the index pregnancy, chronic hypertension and multiple pregnancies were excluded. Cardiovascular morbidity was divided into 4 categories according to severity and type including simple and complex cardiovascular events (e.g., angina pectoris and congestive heart failure, respectively), and invasive and noninvasive cardiac procedures (e.g., insertion of a stent and a treadmill stress test, respectively). Kaplan-Meier survival curve was used to estimate cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HR) for cardiovascular morbidity. During the study period 99,291 patients met the inclusion criteria; 4.1% (n=4153) occurred in patients with exposure to fertility treatments. During the follow-up period, patients with exposure to fertility treatments (OI/IVF) did not have higher rates of cardiovascular morbidity (Table). Using a Kaplan-Meier survival curve, patients with an exposure to fertility treatments had no higher cumulative incidence of cardiovascular hospitalizations (Figure). Using a Cox proportional hazards model, adjusted for confounders such as preeclampsia, diabetes mellitus, and obesity, exposure to fertility treatments remained un-associated with cardiovascular hospitalizations (Adjusted HR=1.1; 95% CI 0.9-1.3; P=0.441). Fertility treatments do not pose a significant risk for long-term maternal cardiovascular complications.View Large Image Figure ViewerDownload Hi-res image Download (PPT)