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Towards a Safe Pathway to Biological Parenthood for Pulmonary Arterial Hypertension
Jamie D Ingram1, Scott M Nelson2, Melanie J Brewis1
1Scottish Pulmonary Vascular Unit Golden Jubilee National Hospital Glasgow Scotland UK.
Pulmonary Circulation
|May 21, 2026
Summary
Women with pulmonary arterial hypertension (PAH) face high risks in pregnancy. In vitro fertilisation (IVF) with gestational surrogacy offers a safer path to biological parenthood, utilizing advanced techniques and genetic testing.
Area of Science:
- Reproductive Medicine and Genetics
- Cardiology and Pulmonary Medicine
Background:
- Pulmonary arterial hypertension (PAH) poses significant maternal risks during pregnancy, leading to current guidelines advising against conception.
- Existing guidelines strongly discourage pregnancy for women with PAH due to high risks of morbidity and mortality.
Purpose of the Study:
- To review the evidence for in vitro fertilisation (IVF) as a safe alternative for women with PAH seeking biological parenthood.
- To propose a clinical framework for offering IVF and gestational surrogacy to women with PAH.
- To advocate for a dedicated registry and expert consensus to guide future clinical care.
Main Methods:
- Review of current advances in IVF protocols, including GnRH antagonist stimulation, agonist trigger, personalized gonadotropin dosing, and elective embryo cryopreservation.
- Integration of pre-implantation genetic testing for monogenic disorders (PGT-M) and pre-implantation genetic testing for aneuploidy (PGT-A).
- Consideration of conservative approaches for women declining surrogacy, involving natural cycle frozen embryo transfer and single euploid embryos.
Main Results:
- Modern IVF protocols significantly reduce risks like ovarian hyperstimulation syndrome, enabling oocyte retrieval in high-risk populations.
- PGT-M and PGT-A enhance embryo selection, improving implantation rates and reducing miscarriage risk.
- While surrogacy is preferred, conservative self-managed pregnancy options can mitigate but not eliminate risks.
Conclusions:
- IVF combined with gestational surrogacy is a viable and increasingly safe alternative for women with PAH desiring genetically related children.
- Despite advancements, pregnancy in women with PAH remains high-risk, necessitating continued adherence to guidelines against conception.
- Developing a clinical framework, registry, and expert consensus is crucial for optimizing safe reproductive options for women with PAH.
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