Introduction
Key takeaways
What is IVF?
IVF and reproductive aging
IVF and timing of menopause
IVF and hormonal/biologic stress
IVF and cardiovascular risk
IVF and cancer risk
Psychological and quality-of-life outcomes
Research gaps and limitations
References
Further reading
What does decades of research reveal about IVF and women’s long-term health? Evidence from large cohort studies and clinical guidelines suggests reassuring safety for most outcomes, while highlighting important nuances in reproductive aging, cancer risk, and psychological well-being.
Image Credit: Trenkov / Shutterstock.com
Introduction
Current evidence suggests that assisted reproductive technologies (ART), including in vitro fertilization (IVF), are not associated with a clear increase in long-term major adverse cardiovascular events5 or long-term breast cancer risk7. However, interpreting long-term health outcomes following IVF is complex because many women undergoing treatment already have underlying infertility-related conditions (e.g., endometriosis, anovulation, or nulliparity) that independently influence long-term disease risk.8
Evidence on menopause timing is more limited and derives primarily from small observational studies. One cross-sectional study reported a slightly earlier mean age at menopause among women who had undergone IVF (49.84 vs 50.66 years), though the authors emphasized that the difference may not be clinically meaningful and that baseline differences between groups may contribute to the observed association.4
Guideline-level reviews further note that while breast cancer risk does not appear increased overall after fertility treatment, the evidence base remains heterogeneous and certain outcomes, such as thyroid cancer following heavy clomiphene exposure, remain areas of ongoing investigation.8
This article discusses the impact of IVF on women’s long-term health, focusing on the biological mechanisms of hormonal stress and vascular adaptation that contribute to these effects.
Key takeaways
- Current evidence suggests ART/IVF is not associated with a clear increase in long-term major adverse cardiovascular events or overall long-term breast cancer risk.
- Evidence on menopause timing after IVF is limited and largely observational, with small differences reported that may not be clinically meaningful.
- Underlying infertility-related conditions may independently influence long-term disease risk, complicating causal interpretation of IVF outcomes.
- Short-term complications such as ovarian hyperstimulation syndrome (OHSS) remain clinically important during treatment.
- More long-term prospective research is needed to stratify outcomes by protocol type, number of cycles, and underlying reproductive conditions.
What is IVF?
The World Health Organization (WHO) defines infertility as the failure to achieve pregnancy after 12 months or more of regular and unprotected sexual intercourse. Despite decades of research into its causes, risk factors, and interventions, infertility remains a universal health issue affecting about 17.5% of the adult population.1
IVF is a specialized form of assisted reproduction technology (ART) characterized by the external fertilization of an ovum before its implantation into a healthy uterus. Typically, IVF hormone protocols begin by controlling ovarian stimulation (COS) using exogenous gonadotropins to rescue multiple follicles that would otherwise undergo atresia.2
If necessary, premature ovulation is prevented with gonadotropin-releasing hormone (GnRH) agonists or antagonists. These stimulation protocols can produce supraphysiological estradiol concentrations compared with natural menstrual cycles5, a physiological feature that has prompted investigation into potential cardiometabolic and vascular effects of ART.
IVF protocols culminate in oocyte retrieval and either fresh or frozen embryo transfer (FET). Modern clinical strategies increasingly emphasize single-embryo transfer to reduce complications associated with multiple gestations, which historically contributed to higher obstetric risk in ART pregnancies.
IVF and reproductive aging
Current research primarily investigates the impact of IVF on ovarian longevity through markers such as anti-Müllerian hormone (AMH) and antral follicle count (AFC). Recent 2026 data indicate that AMH levels below 1.1 ng/mL are predictive of embryo transfer cancellation and lower oocyte yield, but do not necessarily indicate poor oocyte quality in younger patients.2
Higher AMH levels are significantly associated with positive implantation. Once a transferable embryo is developed, pregnancy outcomes in young patients with diminished ovarian reserve (DOR) are comparable to those with normal reserve.2
Recent research also suggests that systemic inflammatory markers may correlate with ovarian reserve measures and ovarian response during ART. For example, higher levels of inflammatory indices such as the neutrophil-to-lymphocyte ratio were associated with lower AMH levels, reduced antral follicle counts, and fewer retrieved oocytes in a large retrospective cohort.3
Importantly, these associations do not establish that IVF accelerates ovarian aging itself. Baseline ovarian reserve and the underlying cause of infertility are major determinants of both treatment response and long-term reproductive outcomes.
Image Credit: Thanakorv / Shutterstock.com
IVF and timing of menopause
A cross-sectional study comparing menopausal women who conceived via IVF with those who conceived naturally found a mean menopausal age of 49.8 years in the IVF group and 50.7 years in the control group.4 Although statistically significant, this difference of approximately 10 months was considered unlikely to be clinically meaningful.
It is also important to note that the study sample was relatively small and observational in design, and therefore cannot determine whether IVF treatment itself influences menopausal timing. Women undergoing IVF often have diminished ovarian reserve or other reproductive conditions that may independently predispose them to earlier menopause.4
IVF and hormonal/biologic stress
Because ovarian stimulation protocols involve substantial hormonal exposure, researchers have investigated whether ART may temporarily influence vascular physiology or coagulation pathways. These hypotheses are largely based on physiological observations rather than on direct long-term outcome data.5
Short-term complications such as ovarian hyperstimulation syndrome (OHSS) may occur during fertility treatment and are clinically important because they can involve fluid shifts, vascular permeability, and thrombotic risk.6
At the same time, inflammatory status has been linked to ovarian reserve and ART response in observational studies. These findings support the hypothesis that systemic inflammatory processes may influence reproductive physiology, although causal relationships remain uncertain.3
IVF, Induction, and Other Risks and Side Effects
IVF and cardiovascular risk
A greater prevalence of cardiovascular risk factors such as obesity and polycystic ovary syndrome (PCOS) has been reported among women undergoing ART.
Nevertheless, a systematic review and meta-analysis including more than 500,000 women undergoing ART did not identify a significant independent association between ART and long-term risk of major adverse cardiovascular events, stroke, coronary heart disease, hypertension, or diabetes over approximately ten years of follow-up.5
The authors concluded that ART appears broadly cardiovascularly safe at the population level, although substantial heterogeneity between studies remains, and further research is needed to examine risks associated with specific ART techniques and patient subgroups.5
IVF and cancer risk
The most commonly cited IVF-associated concern is oncological safety, largely because fertility treatments involve hormonal stimulation.
Long-term follow-up data from the OMEGA cohort found that women treated with IVF did not have a higher risk of breast cancer than either the general population or subfertile women receiving non-IVF fertility treatments after a median follow-up of more than 20 years.7
Guideline reviews similarly conclude that breast cancer risk does not appear to increase following fertility treatment overall, though prolonged exposure to clomiphene (for example, more than ten cycles) is generally discouraged.8
Some studies have reported a slightly increased incidence of borderline ovarian tumors among ART patients. However, it remains difficult to determine whether this reflects fertility treatment itself or underlying infertility-related risk factors such as endometriosis, nulliparity, or hormonal disorders.8
Long-term follow-up data also suggest that endometrial cancer risk among women undergoing ART is not significantly higher than that of either the general population or subfertile controls.9
Psychological and quality-of-life outcomes
IVF treatments often involve emotional strain due to repeated procedures, uncertainty of outcomes, and financial burden.10
Long-term psychological follow-up studies indicate that women who remain childless after unsuccessful IVF may experience higher rates of depression and phobic anxiety symptoms compared with women who achieve parenthood.10
However, the majority of participants in long-term follow-up studies report generally good mental health overall, suggesting that psychological vulnerability is concentrated in specific subgroups rather than across all IVF patients.10
Research gaps and limitations
The observational nature of most studies establishes associations rather than definitive causation, highlighting the need for long-term prospective cohort studies.
Several studies also emphasize that women in ART cohorts remain relatively young at the end of follow-up periods, meaning additional decades of observation will be necessary to fully evaluate risks for diseases that develop later in life, including certain cancers.9
Future research should also prioritize larger studies that stratify outcomes by ART procedure type, number of treatment cycles, and underlying reproductive conditions such as PCOS or endometriosis.9
References
- World Health Organization. (2023, September 14). Infertility. https://www.who.int/news-room/fact-sheets/detail/infertility. Accessed on 12 February 2026.
- Madenli, A. A., Ozer, G., & Ozmen, S. (2026). A comprehensive analysis of the impact of low AMH on ART outcomes in young patients. Endokrynologia Polska. Advance online publication. DOI: 10.5603/ep.108916. https://journals.viamedica.pl/endokrynologia_polska/article/view/108916/87828
- Yao, Q., Lu, R., Zeng, Y., et al. (2026). Investigating the association between systemic immune-inflammation index and female fertility: a retrospective cohort study. Journal of Ovarian Research 19(1). DOI: 10.1186/s13048-025-01961-3. https://link.springer.com/article/10.1186/s13048-025-01961-3
- Muharam, R., Sumapraja, K., Pratama, G., et al. (2021). Impact of IVF on the Timing and Symptoms of Menopause. International Journal of Women’s Health 13; 889-893. DOI: 10.2147/ijwh.s322718. https://www.dovepress.com/impact-of-ivf-on-the-timing-and-symptoms-of-menopause-peer-reviewed-fulltext-article-IJWH
- Pivato, C. A., Inversetti, A., Condorelli, G., et al. (2024). Cardiovascular safety of assisted reproductive technology: a meta-analysis. European Heart Journal, 46(8), 687–698. DOI: 10.1093/eurheartj/ehae886. https://academic.oup.com/eurheartj/article/46/8/687/7930726
- Rahman, F., Shams, N., Fatima, L., et al. (2024). Long-Term Effects of Fertility Treatments on Maternal Health. Cureus. DOI: 10.7759/cureus.72464. https://www.cureus.com/articles/292296-long-term-effects-of-fertility-treatments-on-maternal-health#!/
- van den Belt-Dusebout, A. W., Spaan, M., Lambalk, C. B., et al. (2016). Ovarian Stimulation for In Vitro Fertilization and Long-term Risk of Breast Cancer. JAMA 316(3); 300. DOI: 10.1001/jama.2016.9389. https://jamanetwork.com/journals/jama/fullarticle/2533505
- ASRM Practice Committee. (2024). Fertility drugs and cancer: A guideline. American Society for Reproductive Medicine 122(3); 406-420. https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-drugs-and-cancer-a-guideline-2024/
- Spaan, M., et al. (2025). Long-term risk of endometrial cancer after assisted reproductive technology. Human Reproduction 40(4); 739-749. DOI: 10.1093/humrep/deaf018. https://academic.oup.com/humrep/article/40/4/739/8005322
- Vikström, J., Josefsson, A., Bladh, M., & Sydsjö, G. (2015). Mental health in women 20–23 years after IVF treatment: a Swedish cross-sectional study. BMJ Open 5(10); e009426. DOI: 10.1136/bmjopen-2015-009426. https://bmjopen.bmj.com/content/5/10/e009426
Further Reading
Last Updated: Mar 5, 2026