Fertility Drugs Unlikely to Increase Risk of Ovarian Cancer
Aug. 24, 2000 -- Probably the last thing that a woman facing the emotionally and physically draining prospect of fertility treatments wants to hear is that the treatment might increase her risk of ovarian cancer. Even worse is hearing about it years after she has gone through the treatments, especially if she has no pregnancy to show for her efforts.
But that information should be a standard part of every informed-consent discussion in the office of a fertility expert, says Alan DeCherney, MD, professor of obstetrics and gynecology at UCLA School of Medicine. And any woman who was never able to conceive -- particularly if she underwent fertility treatments -- might want to discuss the risks with her doctor.
DeCherney says that most fertility experts already give patients this warning -- not to scare women, but because a controversial study a few years ago suggested that drugs that stimulate the ovaries to produce eggs may also increase the risk of ovarian cancer. He tells WebMD that such a link is actually very unlikely.
"Several years ago, a paper came out that suggested that there was an increased rate of ovarian cancer among women who underwent fertility treatment but who did not conceive," DeCherney says. "Now, as it turns out, women who don't conceive -- with or without fertility treatments -- have a higher incidence of ovarian cancer."
Most fertility experts, though, continue to be cautious about the extended use of drugs that stimulate ovulation, he says.
Suheil J. Muasher, MD, professor of obstetrics and gynecology at the Jones Institute for Reproductive Medicine at the Eastern Virginia Medical School, tells WebMD that the paper that touched off the controversy "was a study of women who received fertility treatments in the 1970s and 1980s with much older drugs that are no longer used."
DeCherney, who is the editor of the medical journal Fertility and Sterility, revisited the controversy when he published an editorial on the issue by two Israeli fertility experts.
Asher Shushan, MD, and Neri Laufer, MD, of the department of obstetrics and gynecology at Hebrew University, Hadassah Medical Center in Jerusalem, write that most reproductive endocrinologists in the U.S. and Canada don't believe that the use of drugs to induce ovulation increases the likelihood of ovarian cancer. Still, most discuss the potential risk with patients before giving them the drugs.
According to the authors, there are three important considerations for doctors: what information should be given to patients, how long ovulation agents should be used, and how women should be monitored after treatments to induce ovulation.
Muasher says that, because the early studies suggested that long-term use of the drugs might be a factor in ovarian cancer, and since the "vast majority of conceptions occur in first three or four months of treatment, in my opinion, the drugs should be stopped after six months." DeCherney says his own approach is even more conservative: "We stop at four months."
Muasher says, too, that "we don't know if the fact that this is seen in women who don't conceive indicates that the cancer was there and thus prevented conception, or if it is possible that the drug could promote the cancer. The association with the drug is, however, weak."
Because ovarian cancer is a disease that mostly strikes women in their 50s, the authors suggest, women who fail to conceive should receive long-term monitoring.
Shushan and Laufer write that it may be advisable "to include a recommendation for surveillance for ovarian cancer after treatment ... and to follow these women more closely."