This is the first in a series of 10 responses to commonly asked questions regarding IVF treatment. (See my previous post for the full list of questions).

#1:
Will IVF TREATMENT……

• INCREASE MY RISK OF CANCER?
• MAKE ME GAIN WEIGHT?
• AFFECT MY EMOTIONAL STABILITY?
• HASTEN THE ONSET OF MENOPAUSE?

Risk of Cancer: During the 80’s and early 90’s, articles appeared suggesting a link between fertility drugs and increased incidence of reproductive cancer. The fear was heightened by a retrospective (hindsight) study from Stanford University which suggested that the use of fertility drugs significantly increased the risk of ovarian cancer. This created such a degree of alarm that most IVF programs were compelled to include waivers in their consent forms and required their patients to sign these after full disclosure of potential risk.

Subsequent prospective (forward looking) studies reported from Europe, Israel, the United States and Australia, completely discounted such a link and proved the original study from Stanford to be flawed. The problem with the Stanford study was that it included a large number of women who had been on clomiphene citrate, often, in consecutive cycles, to induce ovulation. Clomiphene (Clomid) has the same internal structure as a hormone known as diethylstilbestrol (DES) which was used in the 60’s to try and prevent miscarriage and which amongst other effects caused vaginal and cervical cancer in the female offspring of women who were treated with this drug beyond the first trimester.

Furthermore, Clomid has been shown to increase the risk of cancer in mice. Since few IVF programs even use Clomid any longer and when they do it is for an isolated cycle of treatment, this problem is really not applicable when non-clomiphene stimulated cycles are conducted.

A second flaw in this study was that it didn’t take into account that infertile women (especially those who don’t ovulate at all/normally) are at increased risk of developing ovarian cancer and such risk can in part be mitigated by an ensuing pregnancy. It is therefore not surprising that a study such as the one performed at Stanford in the pre-ART era where the patients primarily comprised women with dysfunctional or absent ovulation (who are at increased risk) undergoing ovulation induction with Clomid, would have an incidence of ovarian cancer significantly higher than in a normal fertile population of women.

To extrapolate this risk to include predominantly ovulating women who receive primarily gonadotropins for ovulation induction in preparation for IVF is completely irrational. Besides, gonadotropins are naturally occurring hormones and have not been shown to increase the risk of cancer.

Weight Gain: While the use of fertility drugs and corticosteroids such as dexamethasone, prednisolone and prednisone can result in fluid retention and a temporary redistribution of body fat by altering the body’s hormone and fluid balance, it is not a cause of permanent weight gain. The latter is far more likely to result from emotional stress associated with infertility and ART that often results in overeating. Besides, many women undergoing IVF are advised (often erroneously) to severely cut down on their activity thereby reducing their caloric expenditure.

Emotional Stability: Infertility is a condition of disempowerment. Most women feel very vulnerable and out of control. Those who go to an ART program simply because of its reported success rates may fail to take into consideration the people that will be controlling their everyday activities for a protracted period of time. When confronted by insensitive individuals, they will often suffer and decline emotionally. Both information and human sensitivity are remedies to such problems. Information is empowerment and empathy and understanding are food for the soul.

There is no question that infertility as well as its treatment elicits an enormous emotional toll. This having been said, it is the ability to cope with this stress that differs widely from individual to individual. In my experience, those women who tend to “see the glass half empty” will usually find themselves extremely emotionally volatile prior to, during and after the IVF experience. Those that tend to “see the glass half full” tend to cope much better and in fact, often are on an emotional high around the time of IVF treatment.

Our job as caregivers is to spot those that are under duress and counsel them appropriately. When we are unable to make inroads with such patients, they should be referred for professional counseling and, on rare occasions, may be candidates for psychiatric therapy.

Clearly, IVF performed in certain situations can be more stressful. For example, women who have failed IVF repeatedly, cases where older women and those with diminished ovarian reserve (using own eggs) feel that time is running out for them, patients who have depleted their funds to support future IVF endeavors and those who have shaky relationships with their partners are more at risk of emotional consequences. They need special attention. It is usually not the hormones that trigger these emotional effects. Rather, it is the circumstances surrounding the treatment being administered that are the cause.

Precipitating an Early Menopause: Menopause occurs when all a woman’s eggs are used up. And while it is true that fertility drugs make more eggs available at retrieval, they do not increase utilization of existing eggs. In a natural menstrual cycle, a varying number of eggs begin a developmental journey. Usually, only one or two will ovulate, while the remainder will absorb and never be available for use again. Fertility drugs simply allow those follicles that would otherwise be lost, to continue developing to the point that they become available for harvest. As such, the use of fertility drugs does not hasten the onset of menopause, and the number of ovarian stimulation cycles a woman undergoes will not reduce her overall egg population at a rate that is any greater than that which would occur under normal circumstances.

Please look out for next week’s blog on question #2: Will my baby be normal?