Fertility Topics Explained from the Experts at SFS
Are unsuspecting infertile women at increased risk through the drugs and treatment they administered with fertility treatment? When it comes to fertility drugs (e.g. gonadotropins such as Follistim, Gonal F, Puregon, Bravelle, Menopur, Lupron, Superfact, Ganirelix, Cetrotide etc.,) used in IVF, claims that there are long term serious side effects have been grossly over stated. While it is indeed a fact indiscriminate overdosing of women who is inordinately sensitive to gonadotropins (“high responder”) does increase the incidence of multiple pregnancies and can precipitate the serious complications associated with Severe Ovarian Hyperstimulation Syndrome (OHSS), the risk of this happening can be minimized or even avoided through judicious and individualized approaches to the use. Almost 3 decades ago, following the tragic diagnosis of ovarian cancer in the Saturday Night Live celebrity, Gilda Radner, who had received prior gonadotropin therapy many began to suggest the existence of a cause and effect relationship. A retrospective hastily performed study, reported in a highly prestigious journal, sounded an alarm, raising near panic throughout the field, prompting several other studies followed, mostly prospective, almost, all of which refuted a connection. Recently, the results of a substantial , relatively 30-year study involving >12,000 women showed that the use of conventional injectable fertility hormones for ovarian stimulation in the treatment of infertility does not increase the long-term risk of breast, uterine or ovarian cancer. There was one possible exception that applied to women who took the oral fertility drug, clomiphene citrate for more than 12 cycles in a row, where the risk of breast cancer was slightly increased. But the use of gonadotrophins such as Menopur, Bravelle, Follistim, Gonal-F, and Puregon, commonly used for ovarian stimulation in preparation for IVF was by and large not associated with any increased risk of reproductive cancers. The fact is that infertility itself is associated with an overall increase in the risk of ovarian (and breast) cancer and childless women who have never used gonadotropins develop ovarian cancer with the same frequency as those that have. It should also be pointed out that ovarian cancer cells do not even have follicle stimulating hormone (FSH) surface receptors. Thus the suggestion that such gonadotropins would promote the proliferation of ovarian cancer cells is ridiculous. Lupron and other similar drugs on the other hand are among the safest short-term medications in the infertility arena. Though their prolonged usage can lead to osteoporosis (bone loss), this can be avoided through the concomitant administration of low dose estrogen. This having been said, what should be considered is the fact that any intervention carries with it both an upside and a downside….whether it is driving a car, discharging a fire arm or taking medication. Obviously the level of such risk is directly proportionate to competency, skill and intent It follows that when it comes to fertility treatments, it is incumbent upon the doctor and patient to assess the cost-benefit ratio, and in so doing to base their judgment on fact rather than emotion.
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