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Successful in vitro fertilization in women with Fontan physiology

  • Assisted Reproduction Technologies
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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.

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Funding

Dr. Levine is supported by a grant from the National Institute of Child Health and Human Development, Bethesda, MD (K12-HD001265-15).

Author information

Author notes

  1. Suneeta Senapati and Clarisa R. Gracia are co-senior authors

Authors and Affiliations

  1. 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

    Yuli Y. Kim, Sara L. Partington & Emily Ruckdeschel

  2. Division of Cardiology, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Yuli Y. Kim, Sara L. Partington & Emily Ruckdeschel

  3. Philadelphia Adult Congenital Heart Center, Penn Medicine & Children’s Hospital of Philadelphia, 3400 Civic Center Boulevard, PCAM 2nd Floor E. Pavilion, Philadelphia, PA, 19104, USA

    Yuli Y. Kim, Sara L. Partington & Emily Ruckdeschel

  4. Maternal and Child Health Research Center, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Lisa D. Levine

  5. Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Prakash A. Patel

  6. Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    Suneeta Senapati & Clarisa R. Gracia

Authors
  1. Yuli Y. Kim
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  2. Lisa D. Levine
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  3. Sara L. Partington
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  4. Prakash A. Patel
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  5. Emily Ruckdeschel
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  6. Suneeta Senapati
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  7. Clarisa R. Gracia
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Contributions

All the authors contributed to the study conception and design. Yuli Y. Kim, MD, Suneeta Senapati, MD, and Clarissa Gracia, MD, were responsible for drafting of the manuscript, and all the authors provided critical revisions. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Yuli Y. Kim.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. We consulted extensively with the IRB of the University of Pennsylvania who determined that our study did not need ethical approval.

Consent to participate

The study protocol was approved by the Institutional Review Board at Hospital of the University of Pennsylvania and informed consent was waived.

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Not applicable.

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Kim, Y.Y., Levine, L.D., Partington, S.L. et al. Successful in vitro fertilization in women with Fontan physiology. J Assist Reprod Genet 37, 3017–3023 (2020). https://doi.org/10.1007/s10815-020-01969-2

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  • DOI: https://doi.org/10.1007/s10815-020-01969-2

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