Use of assisted reproductive technologies may raise CVD risks
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Key takeaways:
- PCOS, endometriosis, pregnancy loss and premature ovarian insufficiency are linked to CVD risk in women of reproductive age.
- Assisted reproductive technologies increase CVD risk in women with infertility.
Women with a history of infertility who use assisted reproductive technologies may have increased risk for CVDs, such as preeclampsia, stroke and heart failure, according to a presenter.
“Many of the traditional risk factors [for cardiovascular disease] are, of course, risk factors for women [and men], but additionally, women have unique risk factors throughout the lifespan related to pregnancy and hormones,” Erin D. Michos, MD, MHS, FACC, FAHA, FASE, FASPC, associate professor of medicine and director of women’s cardiovascular health research at Johns Hopkins Medicine and Healio | Cardiology Today Editorial Board member, said during a presentation at the World Congress Insulin Resistance Diabetes & Cardiovascular Disease Conference.
Infertility risk factors
Infertility — failure to establish a clinical pregnancy after 12 months of regular unprotected sexual intercourse — may affect 50% of women of reproductive age in the U.S. and is a risk factor for CVD, Michos said. Various studies have found that women with a history of infertility have increased risks for subsequent CV events, such as incident HF with preserved ejection fraction.
The most common cause of infertility among women of reproductive age is polycystic ovary syndrome, which affects about 10% of women in the U.S. Irregular menses is an identifier for PCOS, Michos noted. Meta-analyses and studies have found that women with a history of irregular menses have about a 53% increased risk for a CV event, and women with a history of PCOS have an approximately 30% increased risk for incident CVD.
Endometriosis, spontaneous pregnancy loss and premature ovarian insufficiency are also associated with CVD risk for women of reproductive age and are common among women with a history of infertility.
“In light of these medical conditions leading to infertility, more women are using assisted reproductive technology,” Michos said.
Assisted reproductive technologies, CVD risk
Use of assisted reproductive technologies (ART) is increasing among women with infertility with up to 2.3% of all infants born in the U.S. conceived through methods such as IVF or frozen embryo transfer, according to Michos.
In a study by Michos and colleagues, women who conceived using ART were 50% more likely to develop preeclampsia and more likely to have acute CV complications, such as HF, stroke and venous thromboembolism, during delivery hospitalization and longer hospital stays and higher costs.
When evaluating risk for CVD and type of ART used, some studies have suggested that frozen embryo transfer, which is the most common ART method, has a stronger link to preeclampsia hypertensive disorders of pregnancy than other methods, Michos said. Preeclampsia increases risks for obstetrical and maternal complications as well as long-term CV risks with a four-fold increased risk for HF and a two-fold increased risk for subsequent CVD, according to Michos.
Compared with fresh embryo transfer, women who undergo frozen embryo transfer have a 60% increased risk for stroke, which parallels the increased risk for hypertensive disorders of pregnancy observed with frozen embryo transfers, Michos said. One explanation for this increased risk, Michos said, may be due to a lack of the corpus luteum — which produces progestin early in pregnancy — and the lack of relaxin — which has relaxing effects in maternal hemodynamics. Lack of these two factors in conception and gestation may increase preeclampsia risk, which increases maternal CV risk, Michos said.
“There are unique opportunities for identifying risk factors in younger women, such as issues related to menstrual cycles, bleeding and adverse pregnancy outcomes, and it is important to have postpartum follow up monitoring,” Michos said. “Taking advantage of these opportunities requires education and awareness for both patients and clinicians.”
References:
- Michos ED, et al. Am J Cardiol. 2022;doi:10.1016/j.amjcard.2022.08.037.
- Oliver-Williams C, et al. EJPC. 2020;doi:10.1177/2047487320939674.
- Soloman CG, et al. JCEM. 2002;doi:10.1210/jcem.87.5.8471.
- Zhao L, et al. Oncotarget. 2016;doi:10.18632/oncotarget.9553.
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Michos ED, et al. Infertility, Assisted Reproductive Technology and Cardiovascular Risk. Presented at: World Congress Insulin Resistance Diabetes & Cardiovascular Disease Conference; Dec. 7-9, 2023; Los Angeles (Hybrid).
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