Assisted Reproductive Technology and Cardiovascular Outcomes in Women: A Systematic Review and Meta-Analysis

Background: Assisted reproductive technology has been linked to an increased risk of pregnancy-related cardiovascular complications, but the long-term cardiovascular outcome is poorly understood. This study aimed to assess whether women who use ART have an elevated long-term risk of adverse cardiovascular outcomes. Methods: We conducted a systematic review and meta-analysis to examine the association between ART and long-term cardiovascular outcomes after pregnancy. We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published by January 2026. We evaluated the methodological quality of included studies using the Newcastle-Ottawa Scale. We used random effects models to calculate pooled adjusted risk ratios (aRR) with 95% confidence intervals (CI) for the association of ART with cardiovascular outcomes. Results: We included thirteen studies comprising 553,331 patients who used ART and 37,826,591 patients who conceived spontaneously. All women achieved a live birth. Mean duration of follow-up after delivery was 8.4 ± 8.3 years. In models adjusted for age, parity, and comorbidity, ART was associated with a small increase in the risk of cardiovascular disease compared with spontaneous conception (aRR 1.18, 95% CI 1.03-1.35), but the association was attenuated when studies that had only 42 days of follow-up were excluded (aRR 1.13, 95% CI 0.99-1.29). ART was not associated with cardiac complications (aRR 0.94, 95% CI 0.82-1.08), stroke (aRR 1.20; 95% CI 0.93-1.55), hypertension (aRR 1.02; 95% CI 0.72-1.44), or venous thrombosis (aRR 1.27, 95% CI 0.97-1.67). Conclusions: Our findings suggest that women who achieve a live birth following ART do not appear to have an increased long-term risk of adverse cardiovascular outcomes. These results provide reassuring evidence for patient counseling regarding the long-term cardiovascular safety of ART among women with successful pregnancies. Further research that includes women who do not achieve a live birth is warranted to more fully characterize the potential long-term cardiovascular effects of ART across the entire spectrum of treatment outcomes.