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Unsuccessful fertility treatment linked to increased cardiovascular risks

A new study that looked at women who had undergone fertility treatments found that cardiovascular problems were more common in the women whose fertility treatments failed compared to those who gave birth.

The study included women who had fertility treatment in Ontario between April 1993 and March 2011. The researchers, led by Dr. Jacob Udell of Women’s College Hospital, identified 28,442 women in the OHIP database who had two or more ovulation inductions in that time period. Of those women, 9,349 (about one-third) gave birth within a year of their final fertility treatment. Fertility treatment was unsuccessful in the other 19,093 women.

The researchers then followed all of the women until March 2015, looking for any one of five types of cardiovascular events:

  • Coronary ischemia (reduced blood flow in the coronary arteries)
  • Stroke
  • Transient ischemic attack (sometimes called a “mini stroke”)
  • Heart failure
  • Thromboembolism (a blood clot that reduces or blocks blood flow)

There were 2,686 women who were treated for one of these conditions during the followup period. Most of these cases were in women whose fertility treatment was unsuccessful: 1,925 cases, compared to 761 in the women who gave birth.

After adjusting for factors that might influence the results (such as age, income and cardiovascular risk factors), the researchers calculated that the rate of cardiovascular events was 21 per cent higher in women whose fertility treatments failed compared to those who gave birth.

This increase was mostly due to increased rates of heart failure and stroke. The rate of heart failure was more than doubled in the women who had unsuccessful fertility treatment, and the ischemic stroke rate was 33 per cent higher. There was no increase in the rate of hemorrhagic stroke.

The researchers also noted that the relative risk of a cardiovascular event was highest in the first year following unsuccessful fertility treatment. The relative risk got progressively smaller over the next few years, and after five years became almost the same as women whose fertility treatment was successful.

The reasons for the higher rates in women whose fertility treatment failed are unknown. They may be related to the fertility treatment itself, or it might be that some cardiovascular risks are increased in women who are also at risk for infertility.

The study results are particularly significant because of the growing use of fertility treatment. The study was published in CMAJ on March 13, 2017.

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  • A publication of:
  • Women's College Hospital