Special considerations in assisted reproductive technology for patients with cardiovascular disease.

Abstract

Many individuals with cardiovascular disease can benefit from the availability of assisted reproductive technologies (ART) for family building. Its use for this population may be due to underlying infertility, a need for fertility preservation prior to disease worsening or heart transplant, a genetic cardiac condition they hope to avoid passing to offspring, or the need to utilize a gestational surrogate in the setting of cardiovascular contraindications to pregnancy. Cardiovascular disease exists on a spectrum, from mild and common diseases that pose minimal threat to maternal health during pregnancy, to severe and rare diseases with a high risk of morbidity and maternal mortality if ART or pregnancy are pursued. In this review, we will characterize the varying cardiovascular diseases from the lens of the reproductive-aged patient undergoing ART. We will classify the necessary steps in the pre-ART evaluation from the multi-disciplinary team, discuss risk stratification prior to ART treatment and possible subsequent pregnancy, and offer specific evidence-based guidance on the care of these patients during the in vitro fertilization and embryo transfer cycles.