Infertility, Infertility Treatment, and Cardiovascular Disease: An Overview

The prevalence of maternal cardiovascular disease (CVD) has risen throughout the developed world, reflecting an increase in acquired cardiovascular risk factors, such as hypertension and diabetes, and the improved life expectancy of those living with congenital and acquired heart disease owing to advances in care. Because many cardiovascular risk factors and conditions are associated with infertility, reproductive-age individuals with CVD may increasingly seek reproductive assistance. The worldwide use of assisted reproductive technologies (ART), such as in vitro fertilisation, with or without intracytoplasmic sperm injection, or intrauterine insemination after pharmacologic ovulation induction have increased steadily over the past several decades. It is incumbent on providers who care for reproductive-age individuals with preexisting CVD or CVD risk factors to understand and appreciate the types of treatments offered and inherent risks related to infertility treatments, in order to guide their patients to making safe reproductive choices in line with their values and preferences. Infertility treatments increase the risk of complicated pregnancy, but whether these risks are compounded among individuals with preexisting CVD is less well known. In this review, we summarise current available evidence regarding short-term and long-term cardiovascular implications of ART among individuals with and without CVD, as well as treatment considerations for these individuals. Existing knowledge gaps and priority areas for further study are presented.