(by Nicola Simonetti) Women undergoing fertility treatment should consult their doctor urgently if they have symptoms of heart failure, according to a study presented at the scientific conference of the European Cardiology Society (Heart Failure 2019) and based on the study by 111 women who had practiced medically assisted fertilization and presented peripartum cardiomyopathy (PPCM). Shortness of breath, swelling of the legs and awakening at night to urinate could be warning signs of heart failure associated with pregnancy called "peripartum cardiomyopathy". This affects about one woman on 1.000 around the world and is potentially lethal for the mother and child. The heart becomes "dilated" at the end of pregnancy or after childbirth.
"It is very difficult to distinguish the normal discomfort of pregnancy from the symptoms of heart failure," said Dr. Tobias Pfeffer, co-author of the study and cardiologist at the Hannover Medical School. "Our study shows that the risk of PPCM is five times higher in women who have fertility treatment. Therefore, they should be aware that this discomfort may not be benign. PPCM is often diagnosed too late, with direct consequences on prognosis. "
"In all women who conceived after medically induced pregnancy, gynecologists and fertility physicians should recommend heart checks, including post-partum echocardiography, or just before, to exclude PPCM," said senior author Denise Hilfiker-Kleiner of the Hanover studio.
It should be noted that the pregnancy rate of artificial insemination varies between 10% and 50% per cycle based on age and method and that, therefore, many women undergo multiple cycles of treatment if the pregnancy does not begin or is loses at an early stage. "Lost pregnancies can also induce PPCM". Women who have developed signs of cardiac stress or impaired function should know that another cycle can increase the risk of becoming seriously ill ".
The increase in success rates and affordability have led to a steady increase in the percentage of children born from assisted reproduction technology (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). In Germany, for example, it has changed from 1,6% in 2006 to 2,6% in 2016 and in Denmark from 6,1% in 2012 to 10% in 2018.
The study found high rates of subfertility in patients with PPCM. A third had difficulty getting pregnant despite regular sexual intercourse for at least six months, compared to around 20% of the general population in Germany. Births using ART were five times more frequent in women with PPCM: 13% of children were conceived with assisted reproduction techniques compared to 2,6% of the general population.
The researchers stated that the high prevalence of subfertility and births derived from ART in patients with PPCM could be partially related to shared risk factors. "Women who undergo artificial fertilization are usually older and childbirth is more often cesarean, so they already have two risk factors for PPCM." Fertility treatments - says Professor Hilfiker-Kleiner - lead to multiple pregnancies overall, which also increases the possibility of PPCM. "
"We also think that there may be genetic alterations that predispose women to subfertility and PPCM, but these analyzes are ongoing," said Manuel List, a co-author and medical student in Hannover. "So far there is no clear evidence that hormonal treatment, which is usually part of fertility therapy, increases the risk of PPCM."
Professor Hilfiker-Kleiner noted that the clinical outcomes of PPCM patients in the study were not worse in women with fertility problems, including those undergoing fertility treatment, than in those with normal fertility. "Having IVF or ICSI is not associated with a worse prognosis from PPCM," he said. "However, as subsequent pregnancies after PPCM have a high risk of relapse, fertility treatment in patients with PPCM presents a high risk for mother and conception product."