Women receiving infertility treatment may be at increased risk for vascular and pregnancy-related complications, new research has found.
Assisted reproductive technology (ART), is the overarching term for infertility treatment in which eggs or embryos are handled to improve the odds of pregnancy. These treatments can involve administering medication to control ovulation timing or procedures such as in vitro fertilisation (IVF) or intracytoplasmic sperm injection.
According to 2019 statistics from the US Centers for Disease Control and Prevention, the use of infertility treatment technology has more than doubled during the past decade. More than 2% of infants born in the US every year are conceived with assisted reproductive technology.
The findings of this study can be discovered in the Journal of the American Heart Association.
Infertility treatment and adverse pregnancy outcomes
“Older women are increasingly turning to assisted reproductive technology. However, advancing maternal age – specifically being age 35 and older – increases the risk of having or developing conditions, such as chronic high blood pressure, that increase the risk of pregnancy complications,” according to study author Pensée Wu, MBChB., M.D., senior lecturer and honorary consultant obstetrician and subspecialist in Maternal Foetal Medicine at Keele University School of Medicine in Staffordshire, United Kingdom.
“Adverse pregnancy complications such as high blood pressure during pregnancy have now been established as risk factors for future cardiovascular disease,” Wu said. “All of this has raised concerns about adverse pregnancy outcomes associated with assisted reproductive technology, yet studies on the topic are few and have inconsistent findings. A better understanding of the potential impact of assisted reproductive technology on women’s risks for cardiovascular- and pregnancy-related outcomes will help inform women considering assisted reproductive technology and is valuable after birth to develop cardiovascular risk reduction strategies.”
For this study, the researchers examined data from the US National Inpatient Sample, which contains all hospital discharges from 1st January 2008 and 31st December 2016. They extracted records for all delivery admissions and specific records that noted the use of infertility treatment, along with cardiovascular and pregnancy-related complications. The researchers evaluated hospital costs, length of stay and many other factors. The study included more than 106,000 deliveries conceived with infertility treatment and more than 31,167,000 deliveries conceived without the use of infertility treatment.
What did the researchers find?
The analysis found the following:
- Women who conceived with infertility treatment were older, at an average age of 35 years, compared to 28 years for those who conceived without it.
- Those who conceived with infertility treatment also had more pre-existing health conditions, such as chronic hypertension, obesity, and diabetes.
- Women with infertility treatment-conceived pregnancies were more than 2.5 times more likely to suffer acute kidney damage, also known as acute kidney failure, and they were also found to have a 65% higher risk for arrhythmia (irregular heartbeat).
- Infertility treatment-conceived pregnancy was associated with a 57% greater likelihood of placental abruption, a serious complication in which the placenta separates from the lining of the uterus; a 38% increased risk of Caesarean delivery; and a 26% higher risk for preterm birth.
- The increased risks were present even amongst the women having infertility treatment who did not have pre-existing cardiovascular risk factors.
- Hospital charges for women who conceived with infertility treatment were an average of $18,705 compared to $11,983 for those who conceived without it.
“We were surprised that assisted reproductive technology was independently associated with these complications, as opposed to being associated with only the existence of pre-existing health conditions or only amongst older women undergoing infertility treatment,” Wu said.
The study highlighted the importance of counselling patients who are considering infertility treatment about health and pregnancy, as well as postpartum-related risks.
“Especially patients with existing cardiovascular risk factors should be counselled about the potentially long-term cardiovascular implications and risks associated with ART,” Wu said. “It’s important for women to know that assisted reproductive technology carries a higher risk of pregnancy complications, which require close monitoring, particularly during delivery. Primary and specialist health care professionals should ensure these risks are communicated and strategies to mitigate them are discussed and implemented.”
A study limitation is its retrospective nature, meaning it is an examination of data that was recorded for reasons other than research, therefore, there may be errors, such as misclassification or misdiagnosis.
“Future research should examine how optimising cardiovascular risk prior to assisted reproductive technology impacts pregnancy complications and long-term cardiovascular health,” Wu said.
