Infertility Treatment Linked to Increased Risk of Stroke Hospitalization, Study Finds

The findings of a cohort study published in Obstetrics and Gynecology suggest a potential link between infertility treatment and increased risk of stroke hospitalization within 12 months of delivery, highlighting the need for screening and follow-up care in the antepartum and postpartum periods. 

While many studies investigated the risk of stroke when undergoing infertility treatment, the results were inconclusive. Researchers designed a new cohort study to more definitively evaluate the risk of hospitalization from hemorrhagic and ischemic stroke hospitalization associated with infertility treatment. 

The retrospective cohort study utilized data from the Nationwide Readmissions Database, covering all-payer hospital inpatient stays in 28 states in the US from 2010 to 2018. The study focused on individuals aged 15 to 54 who had a hospital delivery within a specific calendar year and subsequent hospitalizations during that same year. Statistical analysis was conducted from November 2022 to April 2023, and the study excluded cases where hospital delivery resulted from infertility treatment or spontaneous conception. 

The study aimed to assess the risk of hospitalization for nonfatal stroke within the first year after delivery, with secondary outcomes measuring stroke risk at different postpartum intervals. Cox proportional hazards regression models were utilized to calculate hazard ratios (HR), adjusting for confounding variables. Researchers corrected the effect size estimates through probabilistic bias analysis to mitigate biases from exposure misclassification and other factors. 

Out of 31,339,991 patients, 287,813 individuals (0.9%) underwent infertility treatment, while 31,052,178 individuals (99.1%) conceived spontaneously and delivered. The stroke hospitalization rate within 12 months after delivery was 37 hospitalizations per 100,000 people (105 patients) for those who underwent infertility treatment and 29 hospitalizations per 100,000 people (9,027 patients) for those who conceived spontaneously. The difference in hospitalization rates was 8 hospitalizations per 100,000 people, with a confidence interval of -6 to 21 hospitalizations per 100,000 people.  

The adjusted HR showed that the risk of hospitalization for hemorrhagic stroke was higher (HR = 2.02; 95% CI, 1.13 to 3.61) than ischemic stroke (HR = 1.55; 95% CI, 1.01 to 2.39). Additionally, the risk of stroke hospitalization increased with the time between delivery and hospitalization, particularly for hemorrhagic strokes. After accounting for biases, the association was stronger for hemorrhagic stroke and weaker for ischemic stroke. 

“These findings suggest that infertility treatment is associated with an increased risk of stroke hospitalization within 12 months of delivery; therefore, optimal screening for risk and timely follow-up should be considered to mitigate factors associated with stroke in the antepartum and postpartum periods,” said researchers.  

Reference  

Sachdev D, Yamada R, Lee R, et al. Risk of stroke hospitalization after infertility treatment. JAMA Netw Open. 2023;6(8):e2331470. doi:10.1001/jamanetworkopen.2023.31470