Cardiovascular safety of assisted reproductive technology: a meta-analysis

Abstract Background and Aims The increasing use of assisted reproductive technology (ART) has raised concerns regarding its long-term cardiovascular safety due to potential hormonal imbalances and pro-thrombotic states. This study aimed to assess the long-term cardiovascular risk associated with fertility treatments in women. Methods Following PRISMA guidelines, a systematic review and meta-analysis was conducted in MEDLINE (via PubMed) from inception to January 2024. Randomized, cohort, or case-control studies were included if fulfilling the following criteria: the association between ART and the subsequent cardiovascular outcome was reported and adjusted for confounding factors (at least age); the presence of a control group; and minimum 1-year follow-up. Effect size (ES) estimates of the association between fertility therapy and subsequent cardiovascular disease were pooled using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with the I2 index. This study is registered on PROSPERO (CRD42024505605). Results Of the 7298 articles screened, 10 studies were included, encompassing 500 664 women undergoing ART and 36 395 240 controls. The analysis found no significant increase in the long-term risk of major adverse cardiovascular events [ES 1.04, 95% confidence interval (CI) 0.88–1.23, I2 87.61%, P = .63], coronary heart disease (ES 0.88, 95% CI 0.71–1.10, I2 24.36%, P = .26), stroke (ES 1.21, 95% CI 0.92–1.59, I2 70.40%, P = .17), venous thromboembolism (ES 0.95, 95% CI 0.70–1.28, I2 49.13%, P = .73), hypertension (ES 1.08, 95% CI 0.88–1.32, I2 94.63%, P = .46), or diabetes (ES 1.03, 95% CI 0.86–1.22, I2 78.44%, P = .77). Assisted reproductive technology was associated with a lower risk of heart failure (ES 0.75, 95% CI 0.60–0.94, I2 0.00%, P = .01). Conclusions Assisted reproductive technology use does not appear to be significantly associated with an increased long-term risk of cardiovascular diseases in women. While these findings suggest the cardiovascular safety of fertility treatments, further research is warranted.