1. Among parous individuals, experiencing infertility was associated with lower scores for cardiovascular health at mid-life.

Evidence Rating Level: 2 (Good)

Study Rundown: Infertility, defined as the inability to conceive after at least 12 months of unprotected intercourse, is known to have great impacts on both physical and emotional health; however, the relationship between infertility and cardiovascular health is not well understood. Researchers aimed to assess whether there is an association between infertility and cardiovascular health at midlife among parous individuals. Participants in this study included 468 individuals who gave birth to singleton live pregnancies between 1999 and 2002. A follow-up assessment occurred at the participants’ midlife, between 2017 and 2021, to collect data on history of infertility as well as behavioral, biomedical, and blood biomarker risk factors for cardiovascular disease. A significant association was found between infertility and lower overall, biomedical, and biomarker scores for cardiovascular health at midlife. No significant association was found between infertility and behavioral risk factors for cardiovascular disease. The findings of this study imply that a history of infertility may be a useful biomarker for future cardiovascular health. 

Click to read the full study in JAMA Network Open

In-Depth [prospective cohort]: 468 parous participants were enrolled via the Project Visa study. Pregnant individuals who had delivered a singleton live birth in Boston Massachusetts were recruited between 1999 and 2002. Between 2017 and 2021, researchers conducted a midlife assessment, at which point data were collected on participants’ history of infertility. In addition, researchers assessed the participants’ risk factors for cardiovascular disease, including domains for lifestyle, biomedical, and biomarker risk factors. These variables were chosen based on the American Heart Association’s Life’s Essential 8 (LE8), which was used to generate a score from 0 to 100 to quantify participants’ risk factors for cardiovascular health. Higher scores denoted better overall cardiovascular health status. Mean (SD) age at the midlife assessment was 50.6 (5.3) years. 43.2% of participants reported experiencing infertility. The mean (SD) LE8 score was 76.3 (12.2). Mean (SD) scores for risk factor domains were 76.5 (13.4) for the behavioral domain, 76.0 (17.5) for the biomedical domain, and 78.9 (19.2) for the blood biomarkers domain. Researchers adjusted for confounding factors, including age at midlife visit, race, education, income, perceived childhood body size (age 10), and age at menarche. Overall, those who had experienced infertility were found to have lower LE8 scores at midlife, with the overall score 2.94 points lower (95% CI, −5.13 to −0.74 points), the biomedical score 4.07 points lower, (95% CI, -7.33 to -0.78 pints), and the blood biomarker score 5.98 points lower (95% CI, −9.71 to −2.26 points) compared to those who did not experience infertility. No clinically significant association was found between infertility and the behavioral domain scores. Although the study was limited by its relatively small sample size and exclusion of nulliparous individuals, it did include long-term follow-up period to include its power. As well, researchers did not assess the cause of infertility for the participants, which may have included male-factor infertility. Overall, this study demonstrates an association between infertility and lower overall, biomedical, and biomarker scores for cardiovascular health at midlife among parous individuals. Further research is needed to determine whether infertility could be useful clinically as a risk factor for future cardiovascular health.

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