Grant: Fellowship Award - Women's Health

Infertility, which affects 1 in 6 couples, is defined as failure to become pregnant after intercourse for one year. The diagnosis can include enormous medical, emotional and financial consequences. In the last 30 years fertility treatments, such as artificial insemination and in-vitro fertilization, have helped millions of women become pregnant. These treatments are popular, but can be complicated, and focus attention on achieving pregnancy rather than the long-term effect on general health. Decision making, to an extreme degree, is driven by the hope of a successful pregnancy. We wonder whether the hormones used in fertility treatments might lead to serious heart and lung disease later in life. There are many reasons to consider this a possible risk. Studies have shown an association between long-term risk of cardiovascular disease and; a) certain causes of infertility; b) estrogen supplements in women of all ages; c) pregnancy complications such as gestational hypertension or diabetes; and d) direct circulation damage from hormone exposure. The potential risk is also relevant given societal changes that translate to more people delaying a family until an older age, when they have a higher likelihood of infertility or heart disease. Regardless of eventual success, fertility specialists rarely follow their patients into older age to monitor for unforeseen side effects. In addition, cardiologists who care for older women may neglect to take an obstetrical history. For example, the onset of a heart attack in middle-age usually prompts a search for immediate triggers and rarely a search for remote exposures. A better understanding of the long-term risks would help inform women's decision making in the use of reproductive assistance and inform care in women who have used fertility therapy. The goal of this study is to assess if women who had pregnancies associated with reproductive assistance are at higher risk of premature cardiovascular and lung disease.