Assisted reproductive technology for patients with medical comorbidities.

PURPOSE OF REVIEW: We sought to review current principles for the management of patients with complex medical disease undergoing assisted reproductive technology (ART) and related fertility interventions, focusing on disease-specific considerations, risk mitigation during controlled ovarian stimulation and oocyte retrieval, medication management, peri-procedural anesthesia planning, and multidisciplinary care pathways.

RECENT FINDINGS: Increased use of ART refined the recommendations and guidelines to provide safe fertility planning and treatment in the setting of complex medical disease. Protocols continue to develop to enable safe application of ART for those individuals through a coordinated and patient-centered approach.

SUMMARY: Utilization of ART has expanded to include patients with significant medical comorbidities. These fertility treatments can shorten time to conception when pregnancy-incompatible therapies must be paused, preserve fertility while optimizing health, enable preimplantation genetic testing to prevent transmission of heritable conditions, and allow the use of gestational carriers when carrying pregnancy is unsafe. Success depends on individualized treatment plans developed and coordinated by a multidisciplinary team.