Pregnancy in a Woman with a History of Acute Myocarditis Following Ovulation Induction: A Case Report and Narrative Review

Abstract

Background: Myocarditis in women of reproductive age poses unique challenges for pregnancy planning, particularly when assisted reproductive technology (ART) is considered. Current guidelines lack specific recommendations for pregnancy after myocarditis, especially in the presence of residual ventricular dysfunction or myocardial fibrosis.

Case Presentation: We describe a 43-year-old woman who developed acute myocarditis shortly after controlled ovarian stimulation for in vitro fertilization. Cardiac magnetic resonance imaging confirmed myocardial inflammation with a markedly reduced left ventricular ejection fraction. She was treated with guideline-directed medical therapy and showed progressive improvement on follow-up imaging, including recovery of contractile reserve on dobutamine stress echocardiography. After a comprehensive prepregnancy evaluation and multidisciplinary consultation, she proceeded with frozen embryo transfer, with close surveillance during gestation.

Discussion: This case highlights the importance of individualized, multimodal risk assessment before pregnancy in women with prior myocarditis. Cardiac magnetic resonance imaging and stress echocardiography can provide valuable prognostic information beyond conventional echocardiographic measures. In addition, we review the potential temporal association between ART and myocarditis, outline proposed mechanisms, and summarize current recommendations for reproductive planning in this population.

Conclusion: With careful risk stratification and coordinated care, pregnancy may be considered in selected women with a history of myocarditis.