Infertility: Cures, Cancer and Confusion


Infertility: Cures, Cancer and Confusion

It was the kind of story that makes the day for morning news show producers, and it came right from the source. The New England Journal of Medicine (NEJM), regarded by U.S. journalists as the biblical reference for health and scientific news, reported a link between fertility treatments and ovarian tumors. The authors reported 11 cases of ovarian cancer in 135 Seattle women who had received fertility drugs. Although such a finding is hardly earthshaking, it elicits alarming headlines that instill doubt and confusion in hundreds of thousands of infertility patients across the county who again and again must ponder the price of making a baby.

Who Is Infertile?

Many women trying to conceive for the first time panic if their periods continue for even three or four months. But the standard definition of infertility is unsuccessful conception after one whole year of unprotected intercourse. At that point, a couple should seek a comprehensive examination that includes menstrual and pregnancy history, semen analysis, ovulation tests and sometimes a laparoscopy to detect endometriosis or pelvic adhesions. Such testing determines the causes of infertility in 70 to 85 percent of all couples.

The Options

Once diagnosed, the woman, along with her husband and physician, has choices to make. Sometimes ovulation problems are traced to a hormonal imbalance, such as can be caused by diabetes or thyroid deficiencies. When the imbalance is treated, a woman's regular cycles will be restored. In the absence of definable disease, there can be any number of reasons for infertility, not all of which are clear.

The most common treatment for female infertility is the prescription of one or more of the infertility drugs that have become available over the past 10 to 20 years. Pharmaceutical research has concentrated on linking particular drugs to specific kinds of symptoms. For example, clomiphene citrate (prescribed under the trade names of Clomid or Serophene) is prescribed to stimulate ovulation in women who have infrequent periods (also called long cycles). Human menopausal gonadotropin (hMG), distributed as Pergonal, is designed to stimulate the ovaries to produce several eggs in one cycle. Most infertility drugs contain hormones or agents that control hormones to create just the right hormonal balance for conception.

The Risks

In spite of the headlines, no research to date has uncovered any concrete evidence that infertility drugs cause cancer. Even the NEJM report of September 1994 concluded that, "Although our findings raise the possibility that prolonged use of clomiphene increases the risk of ovarian tumors, additional, larger studies are needed to test this hypothesis." The medical community agreed, with most reactions focused upon flaws in the research itself, rather than on any significant risk.

"It's a number without perspective," says Dr. Bryan Cowan, director of Reproductive Endocrinology at the University of Mississippi Medical Center and Chair of the American College of Obstetrics and Gynecology Subcommittee on Reproductive Endocrinology, about the study. Dr. Cowan highlights several concerns with the Seattle data. He notes that the subjects may have had compounding risk factors for ovarian tumors even before taking fertility drugs and that some of those who recalled taking clomiphene citrate could not recall dosage levels or length of treatment.

At What Price?

The good news reported by the Seattle study is that women who take fertility drugs and go on to conceive reverse almost all risks associated with the drugs they took in the process. A child's birth reduces the mother's risk of ovarian cancer by 40 percent, with subsequent births cutting her chances by another 14 percent. Other studies indicate that women who breast-feed and take oral contraceptives also decrease their risk of ovarian tumors.

But for those who get endlessly entangled in medical tests and treatment modalities with no success, what price is too high? When should a couple abandon their attempts to induce pregnancy?

Finances alone may answer the questions for man people. Clomiphene citrate, which is the least expensive drug on the market, costs between $50 and $100 per cycle, depending on dosage. Pergonal injections run from $500 to $2,500 per cycle; other treatments range anywhere from $500 to $2,500 per cycle, again depending on dosage. These figures don't include the additional costs of office visits, lab fees, ultrasounds and other tests. Couples should definitely look closely at their bank accounts and insurance coverage before entering the maze of medically induced pregnancy, as the emotional toll is large enough to wreak havoc without the added financial strain.

And, until any real evidence emerges linking infertility drugs to cancer, the fear of ovarian tumors should also be set aside. Infertility drugs, like all medications, should be taken with caution and under the managed prescription of a trusted physician. The American Society for Reproductive Medicine, for example, advocates the use of clomiphene citrate for no more than six months, recommending an alternate treatment modality if pregnancy is not achieved within that time. Many physicians agree, particularly in light of the fact that overmedicating can actually alter the menstrual cycle in some cases, making infertility even more difficult to correct in the long term.

Good medical care is the key both to treating infertility and to avoiding ovarian cancer. A woman should plan her attack on infertility under sound guidance and have annual gynecological exams to monitor for tumors or other irregularities.

American Council on Science and Health, Inc.


By Amy Cates Lyle

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