Pulmonary Hypertension
Toward a Safe Pathway to Biological Parenthood for Women With PAH
- Authors: Pulmonary Circulation review group
- Journal / date: Pulmonary Circulation, 2026
- DOI / URL: 10.1002/pul2.70325 | PMID 42164137 | PMC13183777
- Source basis: Full text (open access)
- Study type: Clinical framework / narrative review
- PH group: Group 1 (PAH, including heritable PAH)
- Scope: Proposes a framework for IVF with gestational surrogacy ± PGT-M/PGT-A for women with PAH who want biological children — with current guidelines still recommending against conception
- Key clinical points:
- Modern IVF protocols (GnRH antagonist stimulation, agonist trigger, personalized dosing, elective embryo cryopreservation) have substantially reduced OHSS risk, making oocyte retrieval feasible even in high-risk PAH patients.
- PGT-M allows selection of embryos free of heritable PAH mutations (BMPR2, etc.).
- PGT-A reduces miscarriage and improves implantation.
- For women who refuse surrogacy: natural-cycle frozen single euploid embryo transfer reduces — but does not eliminate — pregnancy risk.
- Why it matters (clinical takeaway):
- Gives PAH clinicians a structured way to counsel patients who ask about fertility, beyond "don't get pregnant."
- The IVF-with-surrogacy pathway is now safer than historically perceived; mention it explicitly in shared decision-making.
- Strongly argues for a dedicated registry to track outcomes — until then, manage these cases through dedicated PAH + high-risk REI partnerships.
- Caveats / limitations: Narrative review. Pregnancy in PAH remains contraindicated per guidelines; the framework describes alternatives to pregnancy, not approval to be pregnant.
- Referenced trials pulled forward: None.