Ivan V is born healthy and hale.

When you trace this line down to Anna Leopoldovna and her offspring, it starts to look like genetic disease (a grandson of Ivan V, son of Praskovia Ivanovna, died at the age of 4 as well, offspring of Anna Leopoldovna muddles the research but anyways, girls in this line were often MUCH healthier than boys). Though to be honest, there is no info on frail constitution of Alexis, and deaths of heirs at the early age were not that uncommon.

This is true, so perhaps, a chance for some relief there. An average reign for descendants between twenty-thirty years, health allowing
 
When you trace this line down to Anna Leopoldovna and her offspring, it starts to look like genetic disease (a grandson of Ivan V, son of Praskovia Ivanovna, died at the age of 4 as well, offspring of Anna Leopoldovna muddles the research but anyways, girls in this line were often MUCH healthier than boys). Though to be honest, there is no info on frail constitution of Alexis, and deaths of heirs at the early age were not that uncommon.

Wasn't there some question mark over whether Anna Ivanovna and her sisters were actually the children of Ivan? I remember reading in one book that as Ivan was so physically infirm there was some doubt he could actually father children so when he was married to Praskovia Saltykova, his sister Sophia probably made sure that some lusty Guardsman stepped in to carry out the bedroom duties in the hope that Ivan would "father" a son.
 
Interesting, would such rumours be used against Alexis, or would that be avoided with success abroad?
 
Alexis Jr. was healthy boy by all records, unlike Ivan who was the frailest of Alexis I children to survive past infancy. So... that depends on whether the behavior of Tsarina gives any reasons for those.
 
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