Long term cardiovascular risk in women prescribed fertility therapy
Open accessAbstract
Objectives The purpose of the study was to investigate whether fertility therapy might contribute to subsequent cardiovascular disease.Background Fertility medications are used for 1% of births yet may also lead to endothelial injury with long-term adverse consequences for the mother.Methods A population-based cohort analysis was performed of women who gave birth in Ontario, Canada, between July 1, 1993, and March 31, 2010, distinguishing those who did and did not receive fertility therapy in the 2 years before delivery. Cox proportional models were derived to estimate hazard ratios with and without adjustment for baseline characteristics. The primary outcome was a composite cardiovascular endpoint of death, nonfatal coronary ischemia, stroke, transient ischemic attack, thromboembolism, or heart failure.Results Among 1,186,753 women who delivered during the study period, 6,979 gave birth after fertility therapy. After 9.7 years of median follow-up, women who delivered after fertility therapy had fewer cardiovascular events than controls (103 vs. 117 events per 100,000 person-years), equivalent to an unadjusted hazard ratio of 0.96 (95% confidence interval: 0.72 to 1.29, p = 0.79) and an adjusted hazard ratio of 0.55 (95% confidence interval: 0.41 to 0.74, p < 0.0001). An apparent relative lower risk was observed across all age and income groups. Women who received fertility therapy also had lower risk-adjusted all-cause mortality, thromboembolic events, subsequent depression, alcoholism, and self-harm (p < 0.01 for each).Conclusions Successful fertility therapy was not associated with an increased risk of cardiovascular disease later in life.
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IVF was reported in 4 of the 6 included studies.
“IVF was reported in 4 of the 6 included studies (23,25,27,34).”
From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [25]
Included studies were population-based retrospective cohort studies (n=2), secondary analysis of the Nurses' Health Study II cohort (n=1), and a single nested case-cohort study that resulted in 2 publications (n=2).
“Studies included were populationbased retrospective cohort studies (n ¼ 2) (28,34), secondary analysis of the longitudinal Nurses' Health Study II cohort (n ¼ 1) (25), and a single nested casecohort study that resulted in 2 publications (n ¼ 2):”
From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [25]
Repeated cycles of ovarian hyperstimulation and associated hyperestrogenemia may cause endothelial injury by affecting the renin-angiotensin system.
“Repeated cycles of ovarian hyperstimulation and associated hyperestrogenemia contribute to a prothrombotic state (23) and may also cause endothelial injury by affecting the renin-angiotensin system (24,25).”
From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [25]
Both IVF and non-IVF approaches often involve repeated cycles of high-dose hormonal stimulation protocols, which lead to potential fluid shifts, endothelial dysfunction, and a prothrombotic state.
“Both IVF and non-IVF approaches often involve repeated cycles of high-dose hormonal stimulation protocols, which lead to potential fluid shifts, endothelial dysfunction, and a prothrombotic state (23)(24)(25).”
From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [25]
Both Farland et al. and Udell et al. reported a reduced risk of incident hypertension in fertility-treated women compared with women without such treatment.
“Both Farland et al. (25) and Udell et al. (28) reported a reduced risk of incident hypertension in fertility-treated women compared with women without such treatment, whereas Westerlund et al. (27) found a significant 27% increase in this risk.”
From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [25]
Only 1 of our included studies, a large longitudinal cohort of women, had sufficient data to report such comparisons.
“Only 1 of our included studies, a large longitudinal cohort of women, had sufficient data to report such comparisons (25).”
From Cardiovascular Risk Following Fertility Therapy (2017) · cites this paper as [25]
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- Authors
- Udell, J. A., Lu, H., & Redelmeier, D. A.
- Affiliations
- University of Toronto (CA)
- Institute for Clinical Evaluative Sciences (CA)
- Sunnybrook Health Science Centre (CA)
- Corresponding author
- Udell, Jacob A.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2013-10
- Volume
- 62
- Issue
- 18
- Pages
- 1704-1712
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2014612640
- Cited by
- 90
- References
- 47
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 11 · 2023: 4 · 2022: 9 · 2021: 8 · 2020: 7 · 2019: 5 · 2018: 6 · 2017: 8 · 2016: 5 · 2015: 5 · 2014: 8 · 2013: 4
- FWCI
- 8.85
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Heart and Stroke Foundation of Canada
- Canadian Foundation for Women’s Health
- CHEST Foundation
- Respiratory Health Association of Metropolitan Chicago
- Canada Research Chair in Medical Decision Sciences
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Reproductive Health and Technologies
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Assisted Reproductive Technology and Twin Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- cardiovascular disease, long-term cardiovascular risk, women, endothelial injury, thromboembolism, stroke, myocardial ischemia, heart failure, all-cause mortality, depression, alcoholism, self-harm
- MeSH terms
- Adult, Alcoholism, Cardiovascular Diseases, Depression, Female, Follow-Up Studies, Humans, Infertility, Female, Ontario, Sexually Transmitted Diseases, Thromboembolism, Cohort Studies, Multivariate Analysis, Case-Control Studies, Self-Injurious Behavior, Reproductive Techniques, Assisted
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