Failed Fertility Therapy Linked To Increased Risk of Heart Disease Interview with:

Jacob A. Udell MD MPH FRCPC Cardiovascular Division Women's College Hospital Toronto General Hospital University of Toronto

Dr. Jacob Udell

Jacob A. Udell MD MPH FRCPC
Cardiovascular Division
Women’s College Hospital
Toronto General Hospital
University of Toronto What is the background for this study?

Response: We’ve noticed for a long time that fertility drug treatment can cause short-term complications such as high blood pressure or diabetes in pregnancy. We recently started wondering whether there may be long term consequences for these women years after a baby was or was not born.  To do this, we looked at all women who were treated with fertility therapy in Ontario for the last 20 years, from what we could determine this amounted to more than 28,000 women. We then followed up years later to examine every woman’s cardiovascular health. What are the main findings?

Response: We found that fertility therapy failure was common, with success rates of about 33%. Fertility therapy failure was followed by a 21 per cent relative increase in heart disease, especially for strokes and heart failure, after adjustment/consideration for other risk factors. However the absolute risk was modest, equal to about 4 additional events per 1,000 women over 10 years amongst those who did not deliver a child.

In terms of the mechanism for linking fertility therapy and cardiovascular outcomes, one theory is that fertility therapy acts as a stress test and uncovers those who are destined for medical troubles. An alternative explanation is that repeated cycles of these powerful medications may lead to premature heart disease.  More research will certainly need to be done to determine what is going on, but our feeling is the first theory is most likely. What should readers take away from your report?

Response: We certainly don’t want to alarm women who undergo fertility therapy and want to emphasize this is not a reason not to try when its recommended by a physician to achieve pregnancy; the risks were modest and occur years after treatment. We are instead suggesting that as women age, they should stay mindful of their health and remind their family physician about any fertility therapy years earlier. As women (and men) approach middle age, the risk of heart and stroke disease begins to rise. This risk factor, unique to women, may be another consideration when discussing and recommending regular exercise, sensible eating, smoking cessation, blood pressure control and cholesterol management. What recommendations do you have for future research as a result of this study?

Response: The biggest limitation of our study is that we don’t know exactly which drugs, and what doses, and with what degree of monitoring was received by these women. Another limitation is that the average woman was in her late 40s at the end of our study, so that there may be more issues to come in the years ahead. We plan to undertake further research to address these questions.  Furthermore, it will be important to independently validate our observations. Thank you for your contribution to the community.


Failure of fertility therapy and subsequent adverse cardiovascular events Jacob A. Udell MD MPH, Hong Lu PhD, Donald A. Redelmeier MD MSHSR

CMAJ 2017 March 13;189:E391-7. doi: 10.1503/cmaj.160744

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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