Fertility Treatment Might Cause Ovarian Cancer (But Your Doctor is Unlikely to Tell You That)

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.

About Ellen Painter Dollar

Ellen Painter Dollar is a writer focusing on faith, parenting, family, disability, and ethics. She is the author of No Easy Choice: A Story of Disability, Faith, and Parenthood in an Age of Advanced Reproduction (Westminster John Knox, 2012). Visit her web site at http://ellenpainterdollar.com for more on her writing and speaking, and to sign up for a (very) occasional email newsletter.

  • Mary Caler

    Very interesting. I agree with your assessment of the state of reproductive medicine in the US and the dynamics that often are at play in the way people move forward with treatments. When I first saw a reproductive endocrinologist after 1 year of trying to conceive, after a battery of tests that revealed no real problems, the doctor said: “Well, let’s try Clomid and IUI.” And we said, “Hm, we’re not sure about that.” And he said, “Well, think about it. Here’s a prescription for Clomid. Call us if you decide to take it.” Seriously. We left the office with the prescription in hand and no other information about the drug. It was very strange.

    The study discusses IVF — so does that mean that the cancer risk is different/higher with the drugs/dosages used for IVF as opposed to the routine prescribing of Clomid for IUI or natural conception? Does that question make sense? What I’ve read about Clomid seems to indicate that it does increase the risk of ovarian cancer and for that reason, should not be used for more than 6 cycles.

    • http://www.ellenpainterdollar.com Ellen Painter Dollar

      I’m guessing you know more about Clomid than me, but this study was solely looking at the high doses of injected hormones involved in IVF (as well as egg donation). I think the question of whether the risk is greater than with Clomid is a separate question…one that I’m guessing hasn’t been looked at, though I might be wrong. Intuitively, it seems reasonable that b/c the doses are so much higher in IVF/egg donation (because the goal is to mature multiple eggs, not just one or two to allow for natural conception), the cancer risk would be higher. But I know enough about medical research to know that intuition is often wrong. I’m not really answering your question, obviously! It’s a good thing for me to look up! But it’s a great question.

      One of the landmark things about this study, from what I read, is that they used “subfertile” women as a control group—women who had trouble conceiving but who did not undergo IVF. By doing so, they hoped to eliminate the possibility that increased cancer rates following fertility treatment might be due to either an underlying problem that contributed to the women’s infertility, or to the fact that many of the women ultimately never had any children, which in itself can raise the risk for certain kinds of cancers.

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  • http://www.eggsploitation.com Jennifer Lahl

    There is actually a very good study which came out in 2008 from Hadassah-Hebrew University in Jerusalem, Israel on Clomid. This study linked Clomid use to uterine cancer, borderline-significant increased risk of breast cancer, increased risk of malignant melanoma and non-Hodgkin lymphoma.

    Ellen, can you point me to the ‘junk science’ in Eggsploitation? We took great care in the making of this film, quoted the risks of egg donation from the national academies of science, interviewed the former medical director of the FDA and have had the film endorsed/vetted by Dr. Don Landry, chair of the Dept. of Medicine at Columbia School of Medicine. Since you repeatedly make this claim, I’d be curious on what you base that claim?

    • http://www.ellenpainterdollar.com Ellen Painter Dollar

      Hi Jennifer. I’ll respond to your question in Monday’s post. Thanks,
      Ellen


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