For those planning to become pregnant, there is an often overlooked yet vital factor: the connection between heart health and fertility.
The growing recognition of the intersection between these two specialties has paved the way for increasingly collaborative care models and shown how fertility and cardiovascular health cannot be treated in isolation. In fact, early referrals, shared decision-making, and team-based care can significantly improve outcomes, particularly for high-risk patients.
In this Q&A, Tia Jackson-Bey, MD, a reproductive endocrinologist and infertility specialist at RMA of New York and Assistant Clinical Professor, Obstetrics, Gynecology and Reproductive Science, at the Icahn School of Medicine at Mount Sinai, and Ruwanthi Wijesinghe, MD, a cardiologist at Mount Sinai and Assistant Professor of Medicine (Cardiology), explain why maintaining a healthy heart is crucial for reproductive success, how multidisciplinary care can enhance patient outcomes, and steps you can take before, during, and after pregnancy to improve your overall heart health.
Tia Jackson-Bey, MD
What are some common cardiovascular risk factors, and what is their connection to fertility success?
Many of the chronic conditions that affect cardiovascular health also affect fertility. This includes high blood pressure (hypertension), obesity, diabetes, and dyslipidemia. For example, diabetes can cause hormonal imbalances, and dyslipidemia—a condition in which fats in the blood are too high or too low— can affect your cardiovascular health, which in turn can affect ovarian function, hinder implantation, and even prevent the proper development of the placenta.
One critical area that has often been overlooked is a condition called endothelial dysfunction. The endothelium, a thin layer of cells lining blood vessels, plays a pivotal role in vascular health. Disruptions to endothelial function can impair blood flow to the uterus, disrupting implantation and placental development. For women looking to conceive, managing these risk factors before conception is vital for both heart health and reproductive success.
What are some ways to improve overall heart health, both before and during pregnancy?
The same general risk factors that affect your health overall affect your pregnancy and overall wellbeing. It is important to maintain a healthy diet, physical fitness, good weight, and proper levels for blood pressure and cholesterol, as well as control your blood sugar levels and reduce smoking (ideally, to quit). Sleep quality and duration has been linked as a factor in cardiovascular health; it also has a huge effect on hormonal function, which is critical to fertility. Creating a well-balanced, healthy lifestyle is an important first step.
What are some tips you would give to women who are trying to get pregnant now?
The best thing you can do to make a baby healthy is make sure you are healthy before pregnancy. Everything you do in pregnancy helps not just you, but also the baby. If you have high blood pressure, weight issues or high blood sugar levels (hyperglycemia), it can be worth pausing and getting things more under control. Optimizing your medical health prior to pregnancy can not only increase your chances of success, but also help you and your baby maintain good health for the long-term.
Ruwanthi Wijesinghe, MD
What occurs during a cardiovascular checkup, after a referral from a reproductive, endocrinology, or infertility specialist has been made?
We review a variety of metrics and see where we can make targeted changes before trying to conceive, as well as during and after pregnancy. We look at whether a patient is presenting a healthy weight and check blood pressure, as well as review sugar and cholesterol levels. We discuss cardiologic risk factors during pregnancy, like preeclampsia—high blood pressure that occurs generally later in pregnancy—and cardiomyopathy, a weakening of the heart muscle. We also talk about family history of pregnancy and look at congenital heart disease to see if that runs in the family; it is something we can screen for prior to patients getting pregnant.
What can be done during the process of in vitro fertilization (IVF) to help prevent the continuation of cardiovascular conditions?
We can try to prevent genetic forms of heart conditions in the next generation with testing done prior to pregnancy. If there is a condition caused by a gene mutation there is a way to test embryos prior to pregnancy with preimplantation genetic testing. Making sure patients have a thorough evaluation is important because if this gene mutation is identified, we can prevent passing it to the next generation by doing IVF and screening the embryos for that genetic mutation. Genetic counseling also plays a vital role, enabling both fertility specialists and cardiologists to assess and discuss potential outcomes.
