Blog Update!
For those of you not following me on Facebook, as of the Summer of 2019 I've moved to Central WA, to a tiny mountain town of less than 1,000 people.

I will be covering my exploits here in the Cascades, as I try to further reduce my impact on the environment. With the same attitude, just at a higher altitude!

Friday, December 19, 2008

Fertility drugs and cancer

I decided that I wanted to start doing some sort of Science Friday postings based on either something I wanted to discuss or on some science news that I had recently read.

Since we were discussing a few weeks ago whether or not there was an increased risk to women undergoing fertility drug treatment to harvest eggs (both as egg donors and for women undergoing IVF treatment), an article in the December 10th issue of New Scientist, Fertility Drugs Increase Cancer Risk, caught my eye.

Based on this most recently published study, ovulation-inducing drugs seem to have increased the risk of uterine cancer in a group of women who were treated with the drugs over 30 years ago. In a sample size of 15,000 women that had been followed for thirty years, the women in the group who had received the ovulation-inducing drugs had three times the incidence of uterine cancer than members of the group who had not been given these drugs.

For the women who were getting a specific type of drug which tricks the body into making extra eggs by blocking estrogen receptors (clomiphene), the risk was over four times greater. There were also smaller but significant increases in breast cancer, malignant melanoma and non-Hodgkin's lymphoma associated with taking the drugs.

While it's difficult to draw too many conclusions from this particular study, one thing it does do is bring attention to the fact that more research needs to be done. I think it's also important that the women receiving these drugs be aware of any potential risks so they can be monitored for them.

Now, I am in no way (as I said before in my previous post) against IVF or trying to dissuade women from using IVF as a method of fertility treatment. But, since I have friends who have donated eggs multiple times and my husband worked in IVF for a number of years, this has always been something that has nagged me at the back of my mind: what's the long and short-term risk?

It was one of the warnings on the consent form my friend signed: at the time they did not know what the long-term effects were from the fertility drugs. Mostly the unknown was related to future fertility. So, I wonder if there will be any new information or education (based on this study) given to women receiving ovulation-inducing drugs, or if the results aren't considered that statistically significant to warrant any additional warnings.

Would knowing that you are at a small, but increased risk for a variety of cancers prevent you from using IVF as a fertility treatment if you were a candidate? Would it prevent you from being a donor?

(Image: MBI/Alamy)


Anonymous said...

If I really, really wanted children, then no. There are so many things in the environment that can 'potentially' increase our risk of cancer - so I would think the benefit in this case outweighs the risk. Being a donor is another story. It's not something I would consider, personally, but I can certainly see that others would be dissuaded by this increased risk.

Jenna said...

Me personally? Yeah. Its enough to make me shy away from the idea of ever using these treatments. My husband is adopted and while we both want kids one day (thinking rather soonish actually) if it comes down to it, we've already talked over our options. Cancer is a biggie in my family and I can skip the genetic imperative if it could cost me my life later down the road. If tossing our preventatives and working at it the fun way doesn't pan out - we'll adopt before we mess around with my body chemistry.

Its a personal thing, and I'd never fault a women for trying it... but there are so many kids that need parents, I don't see the point in the added risk in my own life.

Pam! said...

Having been through a 10 year battle with infertility (including Clomiphene, surgeries, IUIs, HSGs, a successful IVF, a spontaneous pregnancy, miscarriage, failed IVF, and another spontaneous pregnancy with 10 weeks to go) obviously I chose to take the cancer risk in order to have children.
That being said, for the first 4 years, I was on Clomid more than any woman should be without being warned of the potential risk of cancer. After doing my own research later I found that there was knowledge of the risk in the medical community at that time as well as a recommended limit to the number of cycles. I was not given the opportunity to make that decision then and it wasn't until I started asking my own questions that it was discussed. I was told that since they weren't sure there was truly a risk they felt it unnecessary to bring into an already difficult situation. I hope that this most recent study will at the very least get doctors and patients to discuss the issue before treatment.

Anonymous said...

From being a donor for someone I didn't know (like most instances of donating blood) this news would absolutely dissuade me.

If *I* were the one trying to have more kids, or if my best friend needed an egg or two - I'd do it without an issue.

Interesting thing to learn about myself.

Farmer's Daughter said...

I don't think I could really answer that question about what I'd do unless I was in the situation. I have a cousin (who's like a sister to me) who may not be able to have kids, and if she asked me to donate eggs or be a surrogate, I probably would. If I couldn't have children, that I probably would want to try IVF. But I can't say for sure without really experiencing it.

Theresa said...

My husband and I don't have kids - just can't have any it seems. We 'tried' for years doing all the measuring, timing, etc. Eventually we just decided we weren't meant to have kids. We were slightly disappointed, but not devastated. Life doesn't always go how you think it will, or how you think it should. That's just the way things are. I just don't understand why anyone would take fertility drugs anyway, even if they were risk free. Can't it just be accepted that not everyone will have kids? What's wrong with that?

Alison Kerr said...

It's all about the risk/reward thing and being in control of our own health choices isn't it? Whether or not I've have chosen IVF I don't know. I'd have appreciated having the choice, but I'd also want to have known the risks.

I think that's wrong that Pam was not told the risks. When there is a recommended limit to drug use people need to be aware of that. I recently lost faith in a medical provider because they did not inform me when the FDA issued details of an identified problem with a medication one of my family members was on. What I wonder is whether the doctor would even have mentioned it if I'd not said I was unhappy. Isn't a doctor supposed to protect a patient? In my book that's not about protecting them from information but protecting them from the consequences of medication.

Anonymous said...

I did fertility, and I was, in fact, warned of the increased cancer risk...which is based not on the drugs...but by how much/many times you ovulate. Since my problem is just getting my body to ovulate in the first place, I wasn't worried. I've ovulated exactly 4 times in my life. My risk for cancer is the same as a woman who had 4 kids without help.

And egg donor's are warned as well, assuming they go to a legit place. My cousin donated about 10 years ago, and she was fully informed about the damage she was potentially causing herself. Including cancer.

If I wasn't done with the reproduction thing, I'd continue with the drugs. My personal risk is quite small.

Alyclepal said...

Living is a risk. For me the reward is worth the risk. I'm going to die someday regardless of how safe I play it. It's good to know about the risks though so we can monitor later in life.

statia said...

I've done fertility treatments over the years and I was aware of the increased cancer risk. Even if I wasn't informed, to me, this is common sense. Anything you're scientifically doing to your body is a risk. Injecting massive amounts of hormones into your body to mind trick it into doing what should come naturally, is bound to come with negative risks associated. That said, our first was the product of an FET. The second due in May was a huge natural surprise. I don't regret doing it for my son. I'm glad I didn't have to subject myself to it a second time though.

On the other hand, one also has to wonder what these drugs do to an embryo/fetus/child over the long term as well. As you well know, you're sometimes on medications for your whole pregnancy. I worry that the preservatives in these meds could be what's causing metal poisoning (possible Autism theory), along with a host of other problems. These are things that might sound out there for some, but the long term effects won't be known for a long time.

Fertility is a roller coaster of emotions. There are people out there who will stop at nothing to try to have their own child. I get that. We had decided had it not worked in within our "emotional time frame" that we would be child free. Any choice you make is going to be riddled with guilt, I think.

And if I had to do it all over again, I would. You can't ever go back to imagine your life without such an awesome person.

Sharlene said...

My twins are the result of fertility treatments. I tried for years to have children with no luck and took clomiphene without it doing me any good. Finally I took injectables called gonal-f which caused me to hyper ovulate, almost die from kidney failure, and be pregnant with my two beautiful children. The pregnancy was pure hell and I don't plan on getting pregnant again. That being said I would have done it all over again to have the children I have now. I wasn't told about increased cancer risks but I can't say I am surprised. I lost my father to cancer and saw the pain and heartache involved but it is not enough to make me want to take one minute of the time I have had with my children away. I could be hit by a car while crossing the parking lot while doing the last of my shopping today. But I am still going shopping. I accept the risk. I think it is very easy for those who don't truly want children or those who can have them without fertility drugs to form opinions of the subject but unless they have experienced the heartache of not being able to conceive, they have no idea what they would do to have a child. Its like having a huge hole in your heart.

Laura said...

Reading the comments churned up this question: Is it harder to loose a loved one that you know or a loved one that you have never known?
Sharlene just wrote that "the heartache of not being able to conceive"...(is)"like having a huge hole in your heart." I don't doubt it. I have yet to try to have a child but I can only imagine how gut wrenchingly, awful it must be to not be able to birth a child.

If I choose to have kids and cannot for some reason get the bun in the oven the natural way, I won't be going the chemical route. Basically, I would morn the loss of a person that never lived. Much like I would morn the loss of anyone who is very close to me that passed away, my boyfriend or my parents for example. It's not the same loss but it does seem simular to me.

MrsSpock said...

Interesting link- I'll have to email it to Our Bodies, our Blog.

There is a lack of studies about infertility and side effects of treatments.

Would I ever trade my son (conceived after 4 rounds of Clomid) for have a slightly smaller risk of uterine (AKA endometrial)cancer? No way.

In interpreting this data, your readers ought to know:

This study did not specify what specific drugs a woman took or for how many cycles. It would be great to know how many cycles of clomiphene they took. Does risk increase with cycles of use?

Knowing this would help doctors decide how much is too much and if there should be lifetime limits on this drug.

There also appears to be no information concerning what other risk factors the women had. As I've shown below, there are many more, including infertility itself.

Do women who become pregnant and carry to term negate any risk they may have occurred?

About infertility:
Ovulation induction can be done by both injectable medication or oral (like clomiphene). Eggs donors and women undergoing IVF will use injectable medication. Oral medication is usually first-line for those whose diagnoses (like severely low sperm count or scarred tubes) would automatically need to be treated by IVF. When diagnosing an ovulatory problem, using clomiphene to "challenge" the ovaries to respond, and then watching their response via ultrasound is a typical testing procedure.

Clomiphene is not used for many months before going on to trying injectables. Since estrogen peaks at ovulation to give that great fertile cervical mucus and create a nice thick uterine lining, more than a few cycles of use will cause cervical mucus to dry up and the lining to thin. Hard to make a baby that way. Most docs limit clomiphene tries to 3-6 cycles for each pregnancy attempt. Some will limit tries to 3-6 cycles for a lifetime. Mine does. Mine was 4 tries.

There are other, more well-studied risk factors for endometrial cancer. These include:
1. Never having been pregnant
2. Irregular ovulation- including PCOS, a common cause of female infertility
4. Many years of menstruation- basically starting early and ending late
5. Estrogen-only replacement therapy
6. A high-fat diet
7. Diabetes

Endometrial cancer is most common in post-menopausal women in their 60s and 70s. It is generally caught in its early stages and has a 5 yr survival rate of 95% when caught in the early stages.

MrsSpock said...

Oops, hard to type while holding a baby:

I should have said:Oral medication is usually first-line for those whose diagnoses (like severely low sperm count or scarred tubes) do not automatically need to be treated by IVF.

savvycityfarmer said...


Little Miss Moneybags said...

I've been considering donating eggs for several weeks. A friend did it a few times and she encouraged me to look into it.

I'm still not sure.

Gretchen said...

I think it really depends on the situation.

Like you said, more research needs to be done.

For example, if there's a slight chance of cancer from pesticides, would you eat non-organic foods, EVER? If there's a slight chance of skin cancer, would you cover your skin 100% every moment you're in the sun, every time?

Like Jenna said, if there is a family history, that would affect your point of view. If you're adopted, that also affects your point of view. If you're otherwise infertile, also will affect your decision.

Maybe the question boils down to, whose life is more important? Ours? Or our future child's? Or is it more important to take a RISK of cancer to give the gift of life to someone else.

Maeve said...

I think we're "damned if we do, damned if we don't", if all the various cancer studies can be believed. If I were in the position of being infertile and wanting children, I don't think a slight risk of cancer would deter me from undergoing fertility treatments. But I don't think I'd have gambled with my health at all, and would have found some other way to deal/cope with being infertile. I can't say for certain though, because I think emotion plays a tremendous role in matters of children.

ecomama said...

Well said Sharlene, you took the words right out of my mouth. I the mother of 27 month old triplets conceived through IVF, and knowing what I know now, and having travelled this incredibly difficult journey, I would do it all again in a heartbeat. I knew before my children were ever conceived that come what may, I was meant to be their mother.

Anonymous said...

Isn't there an increased risk of cancer if you don't have children? I'd love to see statistics of the increased risk of cancer from fertility treatments vs. the increased risk of cancer from never being pregnant, giving birth, and breastfeeding. But my child is screaming right now so I have to go.

Donna said...

Interesting info. I considered infertility treatment and decided against it. I wasn't informed of the cancer risk, but that would have been another reason not to do it. We adopted our son and I wouldn't trade him for anything. I think you love the kids that you have, no matter how they came to you. Wouldn't change a thing.

EJ said...

Off topic but food for future science post (warning very frightening info):
RAID on seeds (Life, itself) ... by Monsanto

Anonymous said...

ADOPT, for pete's sake!! 100% guaranteed to be cancer-free, world-changing, and very low-impact. No matter how hard it may be to make a baby, it's raising it that's the important (and truly challenging) part.

Unknown said...

On November 22, 2008, I was successfully given an IUI following only one round (7 days worth of injections) of fertility treatment. In my case, I was given Bravelle. This was the first and only time I had taken fertility meds.
After 6 weeks of pregnancy, (my third & none have resulted in birth), I miscarried.
Today is August 12, 2009. Today I found out I have ovarian cancer.

Crunchy Chicken said...

April - That is horrible news. I hope you have a large support group of family and friends to help you during treatment. I also found the online community to be very supportive when my husband was going through his cancer treatments.

Make sure you let everyone help you who offers it. Please take care and let me know if there's anything I can do for you!