https://orcid.org/0000-0001-5195-8815
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Carlo Andrea Pivato, Giulio Stefanini, Cardiovascular safety of assisted reproductive technologies: what is next?, European Heart Journal, 2025;, ehaf088, https://doi.org/10.1093/eurheartj/ehaf088
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Extract
This commentary refers to ‘Cardiovascular safety of assisted reproductive technology: a meta-analysis’, by C.A. Pivato et al., https://doi.org/10.1093/eurheartj/ehae886 and the discussion piece ‘Cardiovascular safety of assisted reproductive technologies: what have we learned and what remains unknown?’, by Z. Liang et al., https://doi.org/10.1093/eurheartj/ehaf108.
The need for further research
While our findings reassure the growing population of women relying on assisted reproductive technologies (ART) for conception, we must acknowledge some limitations, as detailed in the manuscript.1 A key limitation is the lack of detailed information on the specific ART used, including the type [e.g. in vitro fertilization (IVF), intracytoplasmic sperm injection], the use of fresh vs. frozen embryos, and the number of cycles required to achieve pregnancy. This lack of granularity precluded comprehensive subgroup analyses, though sensitivity analyses on IVF subgroups yielded consistent results. Furthermore, the retrospective nature of most included studies, often based on registry data, introduced biases such as confounding by indication and incomplete adjustment for important confounders. Pregnancy complications, including pre-eclampsia and gestational diabetes, were more common in ART recipients and are linked to long-term cardiovascular risk.2,3 Of note, some studies included may have underestimated the effect size of the association by adjusting for these mediators. These limitations underscore the need for future research.
