Grant: Operating Grant - Secondary Analysis of Databases

Infertility is a common condition that can lead to enormous medical, emotional and financial consequences. Over the past 30 years assisted reproductive therapies (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 long-term health. Decision making, to an extreme degree, is driven by the hope of a successful pregnancy. Fertility medications that stimulate ovulation carry potential risks that are traditionally considered self-limiting. We wonder whether adverse consequences may linger for an extended interval and contribute to heart disease later in life. There are many reasons to consider this possible risk since other studies have shown an association between cardiovascular disease and certain causes of infertility, hormone use in women, pregnancy-associated hypertension, gestational and direct circulation changes from fertility medication exposure. The concern is important because infertility specialists rarely follow their patients into older age whereas cardiologists may neglect to consider a remote obstetrical history. The onset of a heart attack in middle age usually prompts a search for immediate triggers and rarely a search for distant exposures with unforeseen side effects. As such, a serious gap in understanding may prevail in daily medical care. A better understanding of the health risks associated with assisted reproductive therapies may help inform women's decision making in the use of reproductive assistance as well as guide their general medical care. The goal of this provincial health database secondary analysis is to determine if women who had pregnancies associated with reproductive assistance are at higher risk of subsequent premature cardiovascular disease.