Follicular stimulation for high tech pregnancies: Are we playing it safe?

Fishel, Simon; Jackson, PG

doi:10.1016/0020-7292(90)90743-5

Cited by 15 publications

(18 citation statements)

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“…Oocytes are then retrieved through puncture of the ovarian follicles. Both interventions, ovulation induction and ovarian puncture, were associated, in some studies, with ovarian cancer development (11,12,15,18) , but not in others (25)(26)(27) . In addition, infertility itself has been regarded as a risk factor for both ovarian and breast cancer (28) .…”

Section: Discussionmentioning

confidence: 98%

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The possible association betweenin vitrofertilization treatments and cancer development

Lerner‐Geva

Geva²,

Lessing³

et al. 2003

Int J Gynecol Cancer

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The objective of this paper is to assess whether ovarian hyperstimulation and in vitro fertilization (IVF) are associated with increased risk of cancer development, using an historical cohort analysis of infertile women who attended the IVF unit, Lis Maternity Hospital Tel Aviv Medical Center, Tel Aviv, Israel. One thousand and 82 women participated in the IVF treatment program between 1984 and 1992. Cancer incidence rates were determined through the National Cancer Registry and were compared to the expected rates with respect to appropriate age and continent of birth. Twenty-one cases of cancer were observed as compared to 11 that were expected (SIR 1.91; 95% CI 1.18–2.91). When cancer cases that were diagnosed within one year of the IVF treatment were excluded from the analysis (SIR = 1.46; 95% CI 0.83–2.36), no significant excess risk of cancer was noted. We conclude that in this cohort of infertile women, the higher than expected cancer rate could not be attributed to IVF treatments. Special attention should be made to women who may be diagnosed with cancer during or shortly after IVF treatment.

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Section: Discussionmentioning

confidence: 98%

“…Only few cases of individual ovarian cancer have been described in women that participated in IVF programs (14)(15)(16)(17) . In most of these cases the tumor was diagnosed shortly after the IVF treatment and developed very rapidly (18,19) .…”

mentioning

confidence: 99%

The possible association betweenin vitrofertilization treatments and cancer development

Lerner‐Geva

Geva²,

Lessing³

et al. 2003

Int J Gynecol Cancer

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“…50 Indeed, there have been case reports of women treated with fertility drugs later developing cancers of the breast,51,52 malignant and borderline ovarian cancer,53-64 malignancies of the endometrium,54'65 and melanoma66 and in one case-control study use of fertility drugs, as well as a positive interaction between fertility drug use and weight, were associated with thy- eDrug therapy is defined as follows: clomiphene-with or without other hormones excluding hMG; hMG-with or without any other hormones including clomiphene; other-any hormones excluding clomiphene or hMG. roid cancer.46'67 In several of these patients, the interval between infertility treatment and cancer diagnosis was short.…”

Section: Fertility Drugs and Cancer Riskmentioning

confidence: 97%

A Review of Infertility and Its Treatment in the Etiology of Female Reproductive and Other Cancers

Ron¹,

Lunenfeld²

1995

Journal of Women's Health

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Although infertile women do not appear to have an increased risk of cancer when all sites are combined, nulliparity is associated with an increased risk of cancers of the breast, ovary, and endometrium; elevated risks of female reproductive cancers have been reported in some studies; and use of fertility drugs was found to significantly increase the risk of ovarian cancer in a pooled analysis of three case-control studies and in one cohort study. Because specific causes of infertility were not always classified precisely, fertility drugs were not evaluated in many studies, the number of cases is limited, and problems in separating effects of nulliparity, infertility, and fertility drug usage remain, these results should be interpreted cautiously. With an estimated 10% of couples unable to conceive and the use of fertility drugs increasing dramatically, there is a need to clarify the role of infertility and fertility drugs in the induction of cancer. INFERTILITYNULLIPARITY HAS BEEN A CONSISTENTLY reported risk factor for cancers of the breast1, ovary2, and endometrium3, and a strong relation between age at first birth and breast cancer has been demonstrated.1 However, the biologic mechanism for the association between nulliparity and female sex-specific cancers remains unclear. Pregnancy may be protective against these cancers, or a common hormonal disorder may cause both infertility and cancer. Data from the Iowa Women's Health Study4 indicate that 57% of nulliparous married women were unsuccessful in their attempts to become pregnant, so clearly nulliparity, late age at first birth, and involuntary infertility or difficulty in conceiving are correlated.Several hypotheses suggest a strong role for endogenous hormones in cancer induction. Excessive estrogen, as well as "unopposed" endogenous estrogens, have been linked to cancers of the breast1 and endometrium.5 The etiology of ovarian cancer has been related to two main hypotheses: (1) "incessant" or repeated ovulation may cause trauma to the ovarian epithelium that leads to malignant transformation,6 and (2) persistent stimulation of the ovary by pituitary gonadotropins may have a direct carcinogenic effect or may act through or in conjunction with raised concentrations of estrogens.7 Epidemiologie observations support these hypotheses, and animal data show an association between elevated gonadotropin levels and ovarian tumor promotion.The true prevalence of infertility is unknown, is directly related to how wide or narrow a de-

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“…For example, if a twenty year old female is told she has a 1% chance of hemorrhaging, a 1% chance of having a post operative infection, and a remote chance of death with an egg donation procedure; can she accept this? Can she understand the long-term risks of fertility drugs, including the risk of cancer [17-19]? This young woman may very well understand these risks, but can she actually accept the fact that she has a remote, yet possible chance of getting cancer or dying?…”

Section: Debatementioning

confidence: 99%

The student and the ovum: The lack of autonomy and informed consent in trading genes for tuition

Papadimos

2004

Reprod Biol Endocrinol

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Rising tuition costs have forced university students to become creative in finding ways to fund their education. Some female university students have decided that ova donation may be an acceptable alternative in which to pay for their tuition. This alternative presents itself because of the insufficient number of ova available for assisted reproduction and emerging stem cell technologies. Young female university students are encouraged by Internet sources and respectable electronic and print media to donate their ova in the cause of assisted reproduction for monetary compensation. While university students generally exhibit autonomy, the constraining influence of their financial predicament compromises the elements of informed consent (voluntariness, competence, capacity, understanding, and disclosure) as to their making an autonomous decision in regard to egg donation. Thus, any moral possibility of giving informed consent is negated. Informed consent can only occur through autonomy. A female university student in need of financial resources to pay for her education cannot make an autonomous choice to trade her genes for tuition. Donated ova are not only needed for assisted reproduction, but for stem cell technologies. While the long-term health of women who donate their ova is of concern (a potential risk of cancer after long term use of ovulation induction), of equal concern is the possibility of a growth in the trade of ova targeting third world and Eastern European women where the precedence for autonomy and informed consent is not well established.

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Follicular stimulation for high tech pregnancies: Are we playing it safe?

Cited by 15 publications

References 0 publications

The possible association betweenin vitrofertilization treatments and cancer development

The possible association betweenin vitrofertilization treatments and cancer development

A Review of Infertility and Its Treatment in the Etiology of Female Reproductive and Other Cancers

The student and the ovum: The lack of autonomy and informed consent in trading genes for tuition

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