Successful in vitro fertilization in women with Fontan physiology
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ASSISTED REPRODUCTION TECHNOLOGIES
Successful in vitro fertilization in women with Fontan physiology Yuli Y. Kim 1,2,3 & Lisa D. Levine 4 & Sara L. Partington 1,2,3 & Prakash A. Patel 5 & Emily Ruckdeschel 1,2,3 & Suneeta Senapati 6 & Clarisa R. Gracia 6 Received: 5 June 2020 / Accepted: 5 October 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Patients with single ventricle anatomy palliated with Fontan operation are at risk for thromboembolism, arrhythmia, and heart failure rendering pregnancy high risk or even contraindicated. Infertility and high rates of first trimester miscarriage are not uncommon. In vitro fertilization (IVF) with or without gestational surrogacy can be an option, but poses risks during ovarian stimulation, oocyte retrieval, and the post-procedural period. We present six cases of women with complex congenital heart disease status post Fontan operation who underwent successful IVF. Methods Case series from a single-center tertiary care setting. Results Indications for referral were cardiac or fertility concerns for pregnancy of the congenital cardiologist. One woman had mild volume overload after oocyte retrieval requiring furosemide and one experienced post-operative colitis. There were no thrombotic complications. Conclusions A multidisciplinary team-based approach can result in successful oocyte retrieval and IVF in women with complex congenital heart disease and Fontan physiology. Keywords Complex congenital heart disease . In vitro fertilization . Multidisciplinary . Case report
Introduction With survival rates of patients born with congenital heart disease exceeding 85% [1], there are a growing number of females who reach reproductive age desiring pregnancy. Women with single ventricle anomalies palliated with a Fontan operation are at particularly increased risk for adverse pregnancy outcomes. In addition to maternal risks such as heart failure, arrhythmia, thromboembolism, premature rupture of membranes, and post-
partum hemorrhage [2–6], there are well-documented adverse fetal and neonatal outcomes including high rates of miscarriage, intrauterine growth restriction, and premature delivery [7–9]. Furthermore, women with Fontan physiology have higher rates of subfertility and infertility compared with the general population [8] rendering a successful biologic pregnancy even more challenging to attain. In vitro fertilization (IVF), with a gestational carrier (if pregnancy risk is considered prohibitive from a cardiac
Suneeta Senapati and Clarisa R. Gracia are co-senior authors * Yuli Y. Kim [email protected] 1
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Division of Cardiovascular Medicine, Department of Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA Philadelphia Adult Congenital Heart Center, Penn Medi
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