Special considerations in assisted reproductive technology for patients with cardiovascular disease

Many individuals with cardiovascular disease can benefit from the availability of assisted reproductive technologies (ARTs) for family building. Its use for this population may be because of underlying infertility, a need for fertility preservation before disease worsening or heart transplant, a genetic cardiac condition they believe to avoid passing to offspring, or the need to use 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 is pursued. In this review, we characterize the varying cardiovascular diseases from the lens of the reproductive-aged patient undergoing ART. We classify the necessary steps in the pre-ART evaluation from the multidisciplinary team, discuss risk stratification before 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.