Abstract 11: Association Between Infertility Treatment With Assisted Reproductive Technology and Stroke in the United States

Abstract

Introduction: Infertility treatment with assisted reproductive technologies (ART) has previously been associated with adverse vascular events in some, but not all studies. Endothelial damage, prothrombotic factor release, and a higher prevalence of cardiovascular risk factors in those receiving ART have been invoked to explain this association. We sought to explore the relationship between ART and stroke risk using population-level data. Methods: We conducted a retrospective cohort study using data from the National Inpatient Sample (NIS) registry from 2015-2020. We included all delivery hospitalizations for female patients aged 15-55 years. The study exposure was use of ART. Primary endpoints were ischemic stroke (IS), subarachnoid hemorrhage (SAH), intracerebral hemorrhage (ICH), and any stroke (IS, SAH, or ICH) during index delivery hospitalization. Standard International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) algorithms were used to define study exposure, comorbidities, and prespecified endpoints. In addition to reporting population-level estimates, we used propensity score (PS) adjustment by inverse probability weighting (IPW) to mimic the effects of randomization by balancing baseline clinical characteristics (including age and cardiovascular comorbidities) associated with stroke between ART and non-ART users. Results: Among 19,123,125 delivery hospitalizations, we identified 202,815 (1.1%) with prior ART. Those who received ART experienced significantly higher rates of AIS (9.9 vs. 3.4 per 100,000), SAH (7.4 vs. 1.6 per 100,000), ICH (7.4 vs. 2.0 per 100,000), and any stroke (19.8 vs. 6.6 per 100,000) in comparison to spontaneous conception (p < 0.001 for all unadjusted comparisons). Following IPW multivariable logistic regression analysis, ART was associated with AIS [aOR 2.72 (95% CI 2.49, 2.98); p < 0.001], SAH [aOR 4.11 (95% CI 3.63, 4.65); p < 0.001], ICH [aOR 5.11 (95% CI 4.58, 5.70); p < 0.001], and any stroke [aOR 2.70 (95% CI 2.53, 2.88); p < 0.001]. Conclusion: Using population-level data among patients hospitalized for delivery in the United States, we found an association between ART treatment and all stroke outcomes after adjustment for measured confounders.