Two important studies discussing infertility treatments and ovarian cancer received national attention this week. These two studies provide both good news and bad news for women undergoing infertility treatments. Whether the news is good or bad for you depends on the type of infertility treatment you are undergoing.

The first study is one I shared earlier in the blog post: First Phase of Study Shows No Link Between Ovarian Cancer and Infertility Drugs. As the title suggests, researchers found that there was no correlation between ovarian cancer and gonadotrophins, clomifene citrate, human chorionic gonadotrophin, and gonadotrophin. These medications are specifically designed to help a woman produce one follicle per menstrual cycle. The most commonly used and recognizable commercial drug from this group is Clomid.

Retrievel of eggs after ovarian stimulation. Photo courtesy of www.ivfq.com.au

The second study* examined the role of medication used in the IVF process. It is imperative to understand that the medication used with IVF is entirely different from Clomid. The purpose of the medication used with IVF is to cause multiple follicles to develop within one menstrual cycle – known as ovarian stimulation.

The study found that women who underwent ovarian stimulation had a 50% increase in the risk of developing ovarian cancer. However, this 50% only increased the risk from .5% to 1%. The lead researcher in the study, Dr. Burger, posed a question for doctors, “So, what do you tell the IVF patient who comes to your office and asks whether her risk of ovarian cancer is increased? Well, you can tell her the risk after IVF is slightly increased, but it is still increased.”

What are some possible reasons to explain why ovarian stimulation increases the risk of ovarian cancer, while drugs like Clomid do not? First, the more ovulations you have, the more likely you are to get ovarian cancer. This is why women who were pregnant, used birth control pills, or breast-fed their children have a decreased risk of ovarian cancer. Ovarian stimulation also damages the ovaries more, as compared to a single ovulation.

A third possible explanation is that participants in the first study were not followed long enough to assess the long-term affects of drugs like Clomid. The average age of participants at follow-up was 47, even though ovarian cancer is most common at age 60 and above. Researchers said they will continue to follow these women as they age, which may change their conclusions.

I share these studies with you not to generate fear, but because it is imperative for all women to know the risks and benefits of any treatment option before a decision is made. Knowing your risk for ovarian cancer can be a critical deciding factor if you have other risk factors for ovarian cancer, such as a family member with ovarian cancer. To read about the other risk factors and symptoms of ovarian cancer, visit www.ovariancancer.org

*Burger C, et al “The risk of borderline and invasive ovarian tumors after ovarian stimulation for in vitro fertilization in a large Dutch cohort after 15 years of follow-up” SGO 2009; 112(Suppl 1): Abstract 6.

Physicians and patients alike have long wondered if infertility drugs could lead to an increased risk of cancer. Ovarian cancer, the fifth leading cause of cancer deaths in women, has been linked to ovulation and pregnancy. Women who have had more children or ovulated less in their lifetimes (due to oral contraceptives, pregnancy, or breast feeding) have a lower risk of ovarian cancer. The association between ovarian cancer and ovulation lead many researches to question whether drugs like Clomid ® that increase ovulation could lead to an increased risk of ovarian cancer.

A comprehensive study published by BMJ Online followed 54,362 Danish women who used gonadotrophins, clomifene citrate, human chorionic gonadotrophin, and gonadotrophin releasing hormone to improve their fertility. The study concluded that there was no link between these infertility medications and ovarian cancer. Even women who had undergone 10 or more treatment cycles or never became pregnant did not have an increased risk.

Although this study brings extremely good news for women, the results should not be considered final. The participants were followed for 16 years and the average age of participants at the time of follow-up was 47. However, women are most likely to be diagnosed with ovarian cancer in their early 60’s. Researchers acknowledge the age gap and state that they will continue to follow-up with the participants to see if any correlation arises as the women age. The researchers are also quick to point out that, “Some women who take fertility drugs will inevitably develop ovarian cancer by chance alone.”

Ovarian cancer is one of the most lethal cancers because women and their doctors often fail to recognize the symptoms until the cancer is at an advanced stage. Regardless of whether you underwent infertility treatments or not, you should be familiar with the symptoms of ovarian cancer:

• Bloating
• Pelvic or abdominal pain
• Difficulty eating or feeling full quickly
• Urinary symptoms (urgency or frequency)

To learn more about ovarian cancer or its symptoms, please visit: www.ovariancancer.org