Abstract 4141157: Associations Between In Vitro Fertilization and Cardiovascular Outcomes in the United States

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Introduction: Use of in vitro fertilization (IVF), assisted reproductive technology to treat infertility, has risen recently. However, research to date is inconclusive if IVF is associated with increase in cardiovascular disease. We therefore performed a large retrospective study, identifying major adverse cardiovascular and cerebrovascular (MACCE) events in those undergoing IVF. We hypothesize IVF to be associated with an increase in MACCE. Aims: To determine the association between IVF and MACCE. Method: We utilized the TriNetX database (64 healthcare organizations in the United States (US)) to identify women ≥18 years of age who had an IVF-assisted pregnancy. Primary outcomes included overall mortality, acute myocardial infarction (AMI), stroke, peripartum cardiomyopathy, cardiogenic shock, and arrhythmias from index of IVF therapy up to 5 years. We also performed a 1:1 propensity matched analysis of our cohort on 12 characteristics: hypertension, hyperlipidemia, heart failure, atrial fibrillation/flutter, diabetes mellitus, chronic kidney disease, cerebrovascular disease, peripheral vascular disease, body mass index, alcohol abuse, nicotine dependence, and social determinants of health. Results: A total of 35,468 patients met criteria for analysis. Mean age at index was 33.9±5.6 years in the IVF cohort vs 29.4±7.9 years in the non-IVF cohort. The predominant race undergoing IVF were White (71.3%) followed by Asian (5.7%), and Black (5.7%). IVF use was predominant in the Midwest US (44%), followed by the South (25%), West (16 %), and Northeast (14%). There were no statistically significant differences across the 12 baseline characteristics in the matched cohorts. IVF-assisted pregnancy was associated with a decrease in AMI (0.43% vs 0.63%, Risk Ratio (RR) 0.69 (0.56, 0.84)), stroke (0.95% vs 1.83%, RR 0.51 (0.45, 0.59), peripartum cardiomyopathy (0.05% vs 0.18%, RR 0.25 (0.15, 0.44)), and arrythmias (0.93% vs 1.44%, RR 0.65 (0.56, 0.74)). There were no statistically significant differences between cohorts in overall mortality (0.80% vs 0.87%, RR 0.93 (0.79, 1.09)) and cardiogenic shock (0.03% vs 0.03%. RR 1 (0.42, 2.40)). Conclusion: In this large retrospective study of IVF-assisted pregnancy, we found that IVF was not associated with an increase in MACCE. Geographical and racial differences exist in the utilization of IVF in the US which further need investigation, especially socioeconomic status, which may account for the findings in our study.

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