{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:53:43Z","timestamp":1786978423672,"version":"build-2736575974"},"reference-count":38,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T00:00:00Z","timestamp":1779062400000},"content-version":"vor","delay-in-days":47,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pulm. circ."],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Pulmonary arterial hypertension (PAH) carries a high risk of maternal morbidity and mortality in pregnancy, and current guidelines advise against conception. For women with PAH who wish to have genetically related children, in vitro fertilisation (IVF) combined with gestational surrogacy presents a viable and increasingly safe alternative. Advances in IVF protocols\u2014including gonadotropin\u2010releasing hormone (GnRH) antagonist stimulation, agonist trigger, personalised gonadotropin dosing, and elective embryo cryopreservation\u2014have markedly reduced the risks of ovarian hyperstimulation syndrome and made oocyte retrieval feasible even in high\u2010risk populations. The addition of pre\u2010implantation genetic testing for monogenic disorders (PGT\u2010M) enables the selection of embryos free of heritable PAH\u2010related mutations, while pre\u2010implantation genetic testing for aneuploidy (PGT\u2010A) improves implantation rates and reduces miscarriage. For women who, due to personal, cultural or legal reasons, decline surrogacy and choose to carry a pregnancy themselves, a conservative approach\u2014using natural cycle frozen embryo transfer and single euploid embryos\u2014can reduce, but not eliminate, risk. The risks of pregnancy in this population are acknowledged to be high, and the guidelines continue to mandate against PAH patients becoming pregnant. However, there are alternative strategies developing which may allow biological parenthood without some of the inherent cardiopulmonary risk. This paper reviews the available evidence and proposes a clinical framework for offering IVF safely in this population, while advocating for the development of a dedicated registry and expert consensus to guide future care.<\/jats:p>","DOI":"10.1002\/pul2.70325","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:24:19Z","timestamp":1779164659000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Towards a Safe Pathway to Biological Parenthood for Pulmonary Arterial Hypertension"],"prefix":"10.1002","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1334-9845","authenticated-orcid":false,"given":"Jamie D.","family":"Ingram","sequence":"first","affiliation":[{"name":"Scottish Pulmonary Vascular Unit Golden Jubilee National Hospital Glasgow Scotland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott M.","family":"Nelson","sequence":"additional","affiliation":[{"name":"School of Medicine, Dentistry and Nursing University of Glasgow Glasgow Scotland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melanie J.","family":"Brewis","sequence":"additional","affiliation":[{"name":"Scottish Pulmonary Vascular Unit Golden Jubilee National Hospital Glasgow Scotland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin K.","family":"Johnson","sequence":"additional","affiliation":[{"name":"Scottish Pulmonary Vascular Unit Golden Jubilee National Hospital Glasgow Scotland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colin","family":"Church","sequence":"additional","affiliation":[{"name":"Scottish Pulmonary Vascular Unit Golden Jubilee National Hospital Glasgow Scotland UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,18]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2009.02492.x"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehn597"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000020285"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00141211"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-0528"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaf193"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehac237"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2003.12.021"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10815-011-9697-3"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0079-2016"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1080\/14647273.2023.2278295"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm14090915"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201201-0058pp"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1172\/jci129433"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0049-3848(17)30070-1"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.cd001750.pub3"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2020.03.029"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2016.10.033"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2024.05.143"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD008046.pub4"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healun.2022.06.013"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.4103\/2249-4472.165132"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD011184.pub3"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmz037"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1513873"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2025.08.020"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12958-023-01106-5"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.3390\/medicina60081373"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(15)00544-5"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-025-03145-5"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.fertnstert.2020.07.002"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/deae040"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1093\/humupd\/dmad011"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rbmo.2021.03.002"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-023-05752-w"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2021.689764"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcdd9060196"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1086\/682230"}],"container-title":["Pulmonary Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70325","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pul2.70325","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pul2.70325","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T04:41:35Z","timestamp":1783572095000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pul2.70325"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":38,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1002\/pul2.70325"],"URL":"https:\/\/doi.org\/10.1002\/pul2.70325","archive":["Portico"],"relation":{},"ISSN":["2045-8940","2045-8940"],"issn-type":[{"value":"2045-8940","type":"print"},{"value":"2045-8940","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2026-03-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-11","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-18","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70325"}}