A large, comprehensive study in the Netherlands indicates that ovarian stimulation (artificially inducing a woman’s ovaries to produce multiple eggs) increases the risk of ovarian cancer two-fold.
Previous studies examining a possible link between fertility treatment and increased cancer risk were inconclusive for various reasons, including the studies being too small. (That has not stopped some advocates who are uniformly opposed to assisted reproduction from using junk science to make unsubstantiated claims about the link between fertility drugs and cancer, as in the independent film Eggsploitation, which I reviewed here and here.)
So with this new and impressive data, will fertility clinics start publicizing the risks of ovarian stimulation to their IVF patients and egg donors? It’s unlikely. As Gina Marento observed in a Biopolitical Times editorial about the Netherlands study, even the American Society of Reproductive Medicine (ASRM), which advertises lay education as one of its goals, has done a shoddy job of providing good information about the health risks associated with fertility treatments. Marento also observed that college students she talked to were well-aware of the financial benefits of egg donation, but had no idea that there might be health risks involved.
Reproductive technology operates in an emotion- and money-driven environment that makes deliberate, informed decision-making particularly hard for patients. This environment has flourished for a number of reasons:
Reproductive technology serves patients who are highly motivated to undergo treatment, and to do so as quickly as possible. When patients arrive at a fertility clinic, it’s often after months or years of trying to get pregnant. Couples who marry relatively late but hope to have children seek fertility treatment much sooner than that. In most cases, patients feel pressured to try whatever technologies are available, as soon as possible, to maximize their chances of conceiving. As for egg donors, the tens of thousands of dollars that donors from top colleges can get provides an incentive that’s hard to resist if you are a young women buoyed by the idea of paying off college loans in exchange for a few weeks of injections and a minor surgical procedure.
Reproductive medicine is a lucrative specialty that operates under a consumer-driven market model. If patients feel pressured to become pregnant as quickly as possible using whatever means necessary, then their physicians feel similar pressure to treat as many patients as they can, as successfully as possible, in order to attract additional patients. Clinics use their pregnancy rates as advertising fodder to attract patients, many of whom are paying tens of thousands of dollars out of pocket. Both doctors and patients admit that they are reluctant to adopt certain safety measures (such as transferring fewer fertilized eggs to a woman’s uterus to lower the chance of risky multiple pregnancies) because of the perception that doing so will lower the chances of success. In such an environment, it’s hard to imagine that a stringent discussion of potential cancer risks will take place.
Due to a lack of regulatory oversight and the pace of technological innovations, reproductive technology progresses faster than our ability to consider its ethical, emotional, financial, and medical consequences. American fertility medicine (unlike in many European countries) is not regulated. The ASRM issues guidelines (such as on the number of fertilized eggs to transfer, or how much egg donors should be paid), but the guidelines are voluntary and regularly ignored. Fertility clinics are essentially able to offer whatever services they can, to whomever is able and willing to pay. Occasionally, a public outcry will stem the tide of innovation, such as when a California clinic known for pushing ethical boundaries offered preimplantation genetic diagnosis (PGD) for parents wishing to select their child’s eye and hair color, then backtracked in the face of opposition. But such reversals are uncommon. The lack of oversight allows the industry to essentially move forward via human experimentation; we learn about what works, what doesn’t work, and the risks involved not through laboratory findings and extensive trials, but by examining data from people who have undergone treatment. Journalist Liza Mundy, in her book Everything Conceivable, points out the irony of this development, which she traces to the 1995 Dickey-Wicker amendment that forbids government money from being used in any research involving human embryos. In trying to protect nascent human life, advocates of this amendment also effectively removed the fertility industry from any potential for government oversight. As a result, the unregulated fertility industry regularly manipulates embryos in all sorts of ways, and employs more and more complex treatments on patients without anyone (clinicians or patients) understanding all of the risks involved. So much for protecting human life.
The main thing that I advocate for is a more deliberate and informed process for patients (including egg donors) to make decisions about whether or not to use reproductive technology. This process should involve: 1) fertility clinics building in time and resources for patients to receive information, counseling, and support regarding the health, emotional, financial, and ethical dimensions of treatment; and 2) a concerted effort among those in a position to provide that information, counseling, and support (clinicians, counselors, pastors, etc.) to become better informed about those dimensions of treatment.
This new data concerning cancer risk is just one of the many important aspects of fertility treatment that should be a routine part of the introduction to clinical services and patient decision-making…but isn’t.