Association of infertility treatments and incidence of stroke among women: a systematic review.

Abstract: Infertility affects a significant proportion of the global population, leading to an increased demand for infertility treatments among women. There are concerns about the potential association between infertility treatment and stroke. However, this potential association remains poorly understood. The study aimed to address this evidence gap by comprehensively examining the available evidence on the incidence of stroke among women who underwent infertility treatments. The study included retrospective and prospective cohort studies on women who had a history of infertility treatments and were assessed for cerebrovascular accident or stroke. The primary outcome was the incidence of any type of stroke. We searched PubMed, Embase, Cochrane, Web of Science and CINAHL databases using a structured search strategy. Out of 1,076 identified studies, six were included in qualitative synthesis, with a pooled sample size of 406,438 women. Meta-analysis could not be performed due to significant heterogeneity across the studies. The reported incidence of any stroke varied from 16 to 437 per 100,000 person-years. The associations between ART treatments and stroke were reported with HR ranging from 0.82 (0.68-0.99) to 1.66 (1.17-2.35). The evidence on the association between infertility treatment and stroke is still emerging, hampering definitive conclusions regarding the strength of associations due to the limited number of studies. Key questions remain unanswered regarding postpartum stroke, overall stroke incidence among infertile women, and the specific factors contributing to stroke risk. Future research should focus on prospective studies to elucidate these associations, guiding clinical practice and patient care effectively. Lay summary: Infertility affects many people worldwide, leading more women to seek medical treatments to help them conceive. As these treatments become more common, there have been questions about whether they might increase the risk of stroke. We reviewed all available research studies that looked at stroke occurrence in women who had received infertility treatments. After searching through medical research databases, we found six relevant studies that together included over 400,000 women. On observation of 100,000 women per year, the number of stroke cases showed wide variation, ranging from as low as 16 to as high as 437. Some studies suggest that fertility treatments (ART) may slightly raise the risk of stroke, while one study found a small decrease in risk. However, these studies were quite different from each other in terms of who they studied and how they measured outcomes, making it difficult to draw firm conclusions. Important questions still need to be answered, such as whether infertile women have a higher stroke risk overall, whether there is an increased risk right after giving birth, and what specific factors might contribute to stroke risk. More research, particularly studies that follow women over time, is needed to better understand these risks and help doctors provide the best care for their patients.