Cardio-metabolic risk factors among young infertile women: a systematic review and meta-analysis

Background: There is currently no concise systematic review or meta-analysis addressing cardio-metabolic risk factors in women experiencing infertility. Objectives: To determine whether infertile women have higher levels of cardiovascular risk factors compared with fertile women. Search strategy: We performed a systematic literature search using PubMed, Embase and CINAHL, Scopus, and additional manual and bibliographic searches for relevant articles (end search date 6 November 2019). Selection criteria: We selected studies that compared cardio-metabolic risk factors in fertile and infertile women of reproductive age. Data collection and analysis: At least two authors independently screened potentially eligible studies. Main results: There was an increased presence of several cardio-metabolic risk factors in infertile women compared with fertile women. Infertile women had statistically significant higher body mass index (BMI), increased total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG) compared with fertile women. Fasting glucose, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and mean arterial pressure were not found to be different between fertile and infertile women. A subgroup analysis revealed that TC, fasting glucose and fasting insulin were increased, and high-density lipoprotein was decreased only in women with polycystic ovarian syndrome compared with fertile women, whereas BMI, TG and LDL-C were statistically significantly increased in women with any indication of infertility compared with fertile women. Conclusions: Infertile women have a higher level of cardio-metabolic risk factors compared with fertile women. This finding has clinical implications for infertile women in general, and those attempting to conceive through medically assisted reproduction. Tweetable abstract: Infertile women appear to have a higher level of cardio-metabolic risk factors compared with fertile women.