There are few decisions more life-altering than a person or couple deciding it is time to start expanding their family. When a couple starts to try to conceive and are not successful, it can be incredibly disruptive and disappointing. Infertility is very common, as it affects one in eight people. Yet, the causes for and treatment of infertility are still confusing for many. Perhaps that’s because we tend to not discuss them, and stigma creates bewilderment.
In Vitro Fertilization (IVF) is a very common treatment for infertility. The CDC reports that approximately four million babies born in the US each year were conceived by IVF. Ubiquitous as it may be, IVF is perplexing for some from the process of IVF to what the side effects are.
For important health questions, it’s best to consult an expert. I talked to Matthew Lederman, MD, a board-certified Reproductive Endocrinologist and Infertility Specialist at RMA of NY, a clinic in Progyny’s Provider Network. Dr. Lederman has a specialty in fertility preservation: egg or embryo freezing for those recently diagnosed with cancer. He serves on the Medical Advisory board of FORCE: Facing our Risk of Cancer Empowered, as well as the Scientific Advisory Board for TEAL: Tell Every Amazing Lady About Ovarian Cancer. Dr. Lederman is an expert on all aspects of fertility and more than qualified to address the question of IVF and Cancer.
In Vitro Fertilization literally means ‘in the glass fertilization.’ What that refers to is fertilization of an egg by a sperm happening in a dish as opposed to ‘in vivo fertilization,’ or fertilization happening in the body. Dr. Lederman explains that an IVF cycle starts with a woman administering daily shots of hormones for 8-12 days. The hormones work to “increase the number of growing follicles, which contain eggs” in a given month. As you give yourself the shots, you are monitored by your doctor to make sure your ovaries are responding to the stimulation medication appropriately. Once the follicles have grown to the appropriate size, “the patient then undergoes an egg retrieval, a minimally invasive procedure taking less than 15 minutes to complete, to remove eggs from the ovaries. Under sedation, a fertility specialist extracts eggs via ultrasound guidance.” If you are freezing eggs, the process stops here. If you are creating embryos, Dr. Lederman goes on to explain that, “the retrieved eggs are fertilized with sperm, and then allowed to grow in the embryology lab.”
The science of IVF is relatively new, as sciences go. The first IVF baby, Louise Brown, is 40 years old. Dr. Lederman says that this young science is rapidly evolving in that, “the current focus is no longer simply on assisting individuals to achieve pregnancy, but advancements in IVF and genomics have shifted the goal to achieve a single healthy baby,” by which he indicates the advances have made possible elective single embryo transfers, which decrease multiple pregnancies (which are inherently more dangerous).
Estrogen and progesterone play important roles in human reproduction. Some cancers, called estrogen and progesterone receptor cancers, depend on estrogen and progesterone to grow. We also know that during an IVF cycle your hormone levels increase. The same hormones that can feed these types of cancer stimulate your ovaries to produce multiple follicles.
However, Dr. Lederman reassured me that IVF does not cause cancer, and he has evidence-based research to back up his assertion. He says that, “well-designed studies to date do not link IVF to breast cancer, invasive ovarian cancer, or uterine cancer.”
I asked him whether the elevated hormone levels during an IVF cycle could cause harm, and he responded by saying that the estrogen level is elevated only temporarily. One of the more recent innovations of IVF includes a special shot at the end of the cycle, called a ‘trigger’ shot. This shot causes the final maturation of the eggs in the ovaries and uses an additional medication to quickly return the hormone levels to baseline.
Dr. Lederman says that research, “was based on old, poorly designed studies that were limited by small sample sizes, imprecise drug exposure information and treatment indication, and short term follow up.” He says that this a question that many of his patients ask him. He reassures individuals and couples that studies show no greater risk for cancer in those who have undergone IVF treatment.
Generally speaking, we can all make responsible choices to decrease our risk of a cancer diagnosis. Dr. Lederman recommends that women maintain a healthy lifestyle, which includes smart food choices and regular exercise. Avoiding smoking is another responsible choice. He also advocates for Hepatitis B and HPV immunizations, as well as safer sex practices, such as prophylactics, to protect against HPV, HIV and Hepatitis, all of which can increase risk of certain cancers. Dr. Lederman says that maintaining annual physician visits, breast exams, skin exams, pap smears, STD tests, mammograms, and colonoscopies will also help keep your health in check.
An infertility journey can be a rollercoaster of really big highs and devastating lows. Knowing you are under the care of a good doctor, such as Dr. Lederman, is paramount. Asking questions, even if they seem silly, will alleviate as much stress as possible. Understanding each step of the process is important to set your expectations and make the best plans. Knowing the risks is vital! I hope it makes it a bit easier to know that cancer isn’t a risk of IVF. Going through IVF can be stressful enough, but understanding that it won’t have lasting effects to your health should help.
Lissa Kline, LCSW is currently the Director of Member Services at Progyny, overseeing the Patient Care Advocates. She worked at Columbia University Medical Center for several years in the division of Reproductive Endocrinology and Infertility. Involved in Patient Services and the Donor Egg Program she loved working patients while they underwent fertility treatment. Lissa graduated with a Master of Science in Social Work from Columbia University.