Abstract Body (Do not enter title and authors here): 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 via MEDLINE (Pubmed) from inception to January 2024. Randomized, cohort or case-control studies were included if fulfilling the following criteria: the association between fertility therapy and the subsequent cardiovascular outcome was reported and conditioned on confounding factors (at least age); the presence of a control group; minimum one-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 with PROSPERO (CRD42024505605).
Results: Of 7,298 articles screened, eleven studies were included, encompassing 606,912 women undergoing ART and 70,562,486 controls. The analysis found no increase in the long-term risk of major adverse cardiovascular events (ES=0.97, 95% CI=0.81-1.16, I²=89.55%, p=0.73), coronary heart disease (ES=0.88, 95% CI=0.71-1.10, I²=24.36%, p=0.26), stroke (ES=1.20, 95% CI=0.96-1.49, I²=48.33%, p=0.11), heart failure (ES=0.74, 95% CI=0.60-0.94, I²=0.00%, p=0.01), venous thromboembolism (ES=1.03, 95% CI=0.78-1.34, I²=54.41%, p=0.85), hypertension (ES=1.08, 95% CI=0.88-1.326, I²=94.63%, p=0.46), or diabetes (ES=1.03, 95% CI=0.86-1.22, I²=78.44%, p=0.77).
Conclusions: ART does not increase the long-term risk of cardiovascular diseases in women. These results support the cardiovascular safety of fertility treatments, though further research into specific ART techniques and extended follow-up is recommended.