Is Infertility Treatment Associated with Stroke-Related Hospitalization?

According to results of a study published in JAMA Network Open, infertility treatment is associated with an increased risk of hospitalization from hemorrhagic and ischemic stroke within 1 year of delivery. Patients receiving infertility treatment had an overall 66% increased risk of being hospitalized for stroke, especially for hemorrhagic stroke, compared with those who delivered after spontaneous conception.

The population-based, retrospective cohort study obtained patient data (N=31,339,991, aged 15 to 54 years) from 2010 to 2018 from the Nationwide Readmissions Database, which tracks all-payer hospital inpatient stays from 28 states across the United States. The International Classification of Diseases, Ninth Revision and Tenth Revision (ICD-9CM and ICD-10-CM) diagnosis codes and procedure coding system were used to identify the cohort for this study. Researchers estimated the association of infertility treatment with stroke-related hospitalization (within 1 year of delivery) by fitting Cox proportional hazards regression models with the interval between delivery and first stroke hospitalization as the person-time. Among those who received infertility treatment (classified as intrauterine insemination and assisted reproductive technology, including in vitro fertilization or gamete intrafallopian transfer, fertility preservation procedures, or use of a gestational carrier; n=287,813), the rate of stroke hospitalization within 12 months of delivery was 37 hospitalizations per 100,000 people (105 patients) vs 29 hospitalizations per 100,000 people (9027 patients) among those who delivered after spontaneous conception (n=31,052,178) (rate difference, 8 hospitalizations per 100,000 people; 95% CI, −6 to 21 hospitalizations per 100,000 people; hazard’s ratio (HR), 1.66; 95% CI, 1.17 to 2.35).

Study limitations include the fact that researchers could not differentiate between types of infertility treatment and could not control for other factors potentially associating infertility treatment with stroke, such as pre-pregnancy hypertension or diabetes and hypertensive disorder of pregnancy.

Cardiovascular disease (CVD) is the leading cause of pregnancy-related deaths, and stroke accounts for 7% of CVD-related pregnancy deaths. The current American College of Obstetricians and Gynecologists guidelines recommend follow-up within 3 weeks postpartum. This study highlights the importance of CVD risk assessment prior to infertility treatment, and the need for earlier and continued postpartum monitoring, especially for those receiving infertility treatment.