A new study which linked in vitro fertilization (IVF)with an increased risk for breast cancer has caused some concern among patients who are already undergoing – or are planning to undergo – infertility treatments. However, despite the shocking headlines, experts agree that the study’s findings are pure speculation and should not be a reason for women to avoid these types of treatments.
The Australian study, which was published in the medical journal Fertility and Sterility, found that women who underwent IVF were at a slightly increased risk for breast cancer (2%) during their lifetimes, compared to those who took fertility drugs but did not have IVF (1.7%). However, women who had IVF at a young age (around their 24th birthday) were 56% more likely to develop breast cancer than those of the same age group who did not have IVF.
How Breast Cancer and IVF Are Related
Whether breast cancer and IVF or fertility drugs in general are related has been a subject of discussion for decades because infertile women, in principle, are at increased risk to develop breast cancer. Indeed, pregnancies and breast-feeding newborns has for decades been known to reduce breast cancer risk.
When asking whether IVF increases breast cancer risk, one, therefore has to carefully differentiate between the inherent breast cancer risk an infertile woman brings into IVF treatment and any potential additional risk created by the IVF procedure itself.
How IVF in itself could increase breast cancer risk is unknown, but it has been speculated that such risk may be estrogen-related. When women undergo IVF treatment, they are exposed, for a very short period of time, to high levels of circulating estrogen, a female hormone, which is a known risk factor for some breast cancers. However, to think that such a temporary exposure may increase breast cancer risk appears counterintuitive: Pregnancy, a high estrogen state, exposes women to high estrogen levels for nine months.
Linda Giudice, President-Elect of the American Society of Reproductive Medicine (ASRM), failed to make this point when noting in an ASRM press release that “the development of breast cancer is linked to estrogen exposure and the longer one is exposed, the greater the risk.” She continued: “In an IVF cycle, there is a short, but significant elevation in circulating estrogen, and whether this is linked to the observations found in the study is not clear at this time.”
Above noted study results do not prove a cause-and-effect between estrogen exposure and breast cancer risk after IVF. It is equally possible (and maybe even likely) that the original causes of infertility at such unusually young ages (consider how many women seek infertility treatments already at age 24?), like endometriosis, polycystic ovarian syndrome (PCOS), premature menopause, cancer treatments, etc. may be the real culprits.
The study’s lead author, Louise Stewart is, therefore, likely correct in telling Reuters that she doesn’t “think it’s a huge increased risk [for breast cancer] that you should worry or panic (about).” We only wish she and her co-authors had made that point clearer in their published manuscript. It would have prevented this unnecessary fear-mongering!
A new study by CHR casts doubt on the effectiveness of low intensity IVF (LI-IVF) programs, also known as “mini IVF,” “natural IVF” and various other names.
The findings, published in the journal Reproductive Biomedicine Online, revealed that LI-IVF programs, which use lower doses of fertility medications to reduce costs, do not measure up to claims of pregnancy rates comparable to those in conventional IVF.
Many LI-IVF proponents claim that the procedure is more economical and “patient-friendly.” Researchers at CHR decided to evaluate this claim, and matched patients in LI-IVF cycles to comparable patients undergoing traditional IVF cycles. What they found was that patients in LI-IVF cycles produced significantly fewer oocytes and embryos, and demonstrated lower pregnancy rates.
Cost savings with LI-IVF were also unverifiable, as patients took longer to conceive, and needed more treatment cycles to get pregnant than patients in the traditional IVF program.
“LI-IVF appears to reduce pregnancy chances and prolongs time to conception without offering any appreciable compensatory financial benefits,” summarizes Norbert Gleicher, MD, the study’s lead author and medical director of CHR.
Dr. Gleicher adds that while CHR offers the procedure to patients, the center has always explained to patients that LI-IVF is experimental. “As the results of our study well demonstrate, doing otherwise would have been rather unethical.”
David Barad, MD, and co-author of the study added, “We must caution patients against resorting to ‘mini IVF’ or ‘natural IVF’ without carefully weighing their options. Until more data becomes available, physicians should offer LI-IVF only as an experimental procedure.”
Posted on April 5th, 2012
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Seeing the negative effects of delayed diagnosis and treatment in our patients, CHR has developed a fertility tip sheet for young women with possible diminished ovarian reserve (DOR).
Many women under 35 with DOR spend months or years without the correct diagnosis, resulting in significant delays in appropriate fertility treatments.
“Detecting DOR is not difficult,” says Dr. Gleicher, Medical Director and Chief Scientist of CHR. “Ovarian reserve can be easily measured by simple blood tests, like follicle-stimulating hormone (FSH) and anti-Müllerian hormone (AMH). High FSH and/or low AMH suggest a diagnosis of DOR.”
However, many fertility centers often overlook this condition, especially in young women.
As women age, it is normal for FSH levels to increase and AMH levels to decrease. Assessing ovarian reserve by the same standards in younger and older women would, therefore, overlook prematurely abnormal levels in younger women because these levels would be considered within normal range. Using the same values for women of all ages, consequently, does not allow for a timely diagnosis of DOR in younger women.
Young women with DOR usually experience no typical symptoms other than difficulty conceiving. However, blood testing will reveal elevated FSH and/or abnormally low AMH levels for the age of affected patients.
Once diagnosed, it is difficult to predict how rapidly DOR will progress. Though rapid progression is rare, CHR has seen women go into full menopause within months from diagnosis.
To help aid in early diagnosis and treatment of DOR, CHR’s tip sheet aims to spread awareness about this often overlooked infertility diagnosis in young women.
Posted on March 7th, 2012
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Nowadays, nearly half of all patients at the CHR have traveled to us from outside of the New York City and surrounding areas. We understand the challenging economical and logistical aspects of having to seek advanced infertility treatment outside of one’s local community, and have made it our priority to accommodate the specific needs of our long-distance patients.
In our new web page, “Receiving Fertility Treatments in New York City,” we provide our patients with all of the necessary information that they need to know about traveling to us for infertility treatment here at CHR. We offer Skype or phone consultations, coordination with the patient’s local IVF center, and minimal visits to our NYC-based center. We do our best to minimize the logistical challenges while maintaining the highest level of clinical care which we are known for.
If you are interested in becoming a patient at the CHR and are not located in New York City or surrounding areas, please contact us with any questions about our long-distance fertility treatment program!
Posted on February 16th, 2012
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after taking ovarian stimulation drugs; however, it is possible for this condition to develop even without evidence of over-stimulation.
