Oncology and IVF: is there a connection between them?

UNITED STATES, WASHINGTON (OBSERVATORY HEALTH) — A lot of rumors always go around the health of famous people, but these rumors are far from always true.

For example, the media sometimes hint that the cancer of the Russian actress Anastasia Zavorotnyuk provoked IVF. But could this really happen?

Together with specialists, we figured out what in vitro fertilization is and whether it can cause cancer.

What is IVF?

In vitro fertilization (IVF) is a high-tech method of infertility treatment that is resorted to if other ways to conceive a child have not helped. IVF helps to become parents of many infertile couples around the world: over 40 years of existence, thanks to the method, more than 10 million babies have been born.

Although IVF babies are often called “test tube babies,” in fact, only fertilization occurs outside the body of the expectant mother. The embryo is then transferred to the uterus. The future baby grows, develops and is born in the same way as all other babies conceived in a “natural” way.

Does IVF really help to become a mom?

The likelihood of becoming pregnant as a result of the IVF procedure is quite high. According to the doctor of medical sciences, laureate of the prize of the Government of the Russian Federation, creator and head of the ART-ECO reproductive health clinic Elena Andreevna Kalinina , women under the age of 35 become pregnant in an average of 38-40% of cases. For comparison, the frequency of conception without the help of reproductive technologies is about 25-30%.

With age, the chances of getting pregnant as a result of IVF are gradually reduced. For example, women aged 40–42 years become pregnant in no more than 12% of cases. However, when using IVF with preimplantation genetic testing (PGT-A), which helps to select embryos without chromosomal abnormalities, the probability of pregnancy after transfer rises to 65–70%.

Can IVF cause cancer?

Doctor of Medical Sciences, Professor, Head of the Department of New Medical Technologies, MRNTs im. A.F. Tsyba, a branch of the Federal State Budgetary Institution Scientific Research Center for Radiology, Ministry of Health of Russia, obstetrician-gynecologist and oncologist Marina Viktorovna Kiseleva, is convinced that in order to give an augmented answer to this question, it is necessary to rely on randomized multicenter studies. Although such studies have not yet been conducted in the Russian Federation, we have very good foreign data on the basis of which we can conclude that the risk of developing cancer as a result of IVF is small.

For example, experts from the Israeli health service Maccabi conducted a study in which nearly 90,000 women who became pregnant with IVF participated. Of all the study participants, only 41 cases of ovarian cancer, 38 cases of endometrial cancer and 501 cases of breast cancer were recorded. That is, exactly the same as that found in women with a “natural” pregnancy.

The situation in Sweden is even more indicative – a country where a lot of attention is paid to healthcare. Since 1932, all citizens of this country have been included in a special register, thanks to which scientists gained access to health data for all citizens. Including – 1,800,000 women who used either ovulation stimulation or an IVF program to achieve pregnancy.

The health data for this group of women were compared with the health data for 2,000,000 mothers who became pregnant without using assisted reproductive technologies. It turned out that women who used the IVF program were ill with all types of cancer no more often than those who managed to get pregnant in the “usual” way.

Most of the deviations were due to the fact that women who resorted to IVF had health problems before pregnancy.

Where did the rumor come from about the relationship between IVF and cancer?

In vitro fertilization often attracts the attention of the media – which is not surprising, because at least 50 million couples worldwide suffer from infertility . But why then do the media more often write not about the fact that the procedure makes thousands of families happy every year, but about health problems that may be associated with IVF?

Reason number 1: There are many scientific publications on the relationship between IVF and cancer

Doctors and scientists are trying to make IVF as safe as possible in order to avoid the slightest risk to expectant mothers. All the potential dangers associated with in vitro fertilization are studied literally “under the microscope” – even if the risks are small, they try to carefully check them. As a result of the audit, scientific articles appear to which the media react.

Here is an example: according to one of the IVF protocols, at the preparation stage, future mothers are prescribed hormonal drugs that start the maturation of several eggs at once and increase the chances that among the resulting embryos there will be perfectly healthy. At the same time, breast cancer depends on the level of female sex hormones: the more hormones in the body, the higher the risk of getting sick. Scientists have suggested that hormonal stimulation in IVF can trigger breast cancer.

However, a thorough check showed that hormonal drugs used in IVF can not cause breast cancer. All these drugs can do is increase the level of female hormones. Sometimes an increase in hormonal levels can accelerate the development of an existing cancer, which the woman did not suspect.

“This is also why, before the IVF procedure, doctors carry out a detailed examination of the patient, ” says Elena Kalinina. “ This allows you to detect the disease and minimize the risks.”

Reason number 2: people are interested in the life of celebrities

We are interested in all the details of the life of idols – including the state of their health. Therefore, if a young and beautiful actress or singer falls ill, journalists begin to look for the causes of her illness. And since IVF is a fairly well-known method, it often unfairly gets into the spotlight.

“As an example, try to link IVF and brain cancer – glioblastoma. There is no evidence that this very rare tumor is associated with IVF. At the same time, it so coincided that the tumors were found both in Zhanna Friske and Anastasia Zavorotnyuk. – comments Marina V. Kiseleva. – And since it is known that both stars were preparing for IVF, there is a temptation to relate these two circumstances. But what about the fact that opera singer Dmitry Hvorostovsky, comedian Mikhail Zadornov and pianist Mikhail Kogan died from brain cancer? As you yourself understand, male celebrities definitely didn’t do IVF. ”

Reason number 3: Pregnancy and Cancer Can Really Be Connected

Moreover, it doesn’t matter at all how a woman managed to conceive: “naturally” or with the help of IVF.

“Pregnancy is a long process. All these nine months, a woman lives with a completely different hormonal background than she had before her pregnancy. During this period, realignment in the body can really occur, which can trigger the development of cancer, ”says Elena A. Kalinina. – At the same time, pregnancy itself does not cause cancer and does not increase the risks of its occurrence. Typically, problems arise in women who have suffered from the disease before conception. For example, pregnancy can trigger a worsening of the same glioblastoma . But this does not mean that IVF or pregnancy leads to this disease.”

What are the real risks of IVF?

Like any other working treatment method, IVF has limitations and contraindications. That is why, before prescribing in vitro fertilization, the gynecologist or reproductologist carefully examines the health status of the couple and prescribes tests that must be done before in vitro fertilization.

What are the real risks of IVF, we asked Elena Andreevna Kalinina. She spoke about three objectively existing problems.

Danger number 1: Ovarian Hyperstimulation Syndrome

This is an individual reaction to hormonal drugs, as a result of which at the same time much more eggs mature than necessary. Because of this, the ovaries increase in size, and fluid can accumulate in the abdominal cavity and lungs. To avoid the problem, before starting the stimulation, the woman must be carefully examined, and the stimulation itself should be carried out under strict medical supervision.

Danger number 2: Multiple pregnancy

In the 90s, when in our country it was still not possible to preserve the “extra” embryos, all viable embryos could be transferred to a woman – and then pregnancy often triple, quadruple and even fivefold. This complicated the course of pregnancy, leading to premature birth and other problems.

According to clinical recommendations, these days doctors transfer no more than two embryos into the uterus. It is forbidden to transfer more – this is expressly stipulated in the order of the Ministry of Health No. 107n, which regulates the work of reproductologists in our country.

Over the past years, the level of modern embryological laboratories has grown. If today reproductologists transfer only one embryo, the likelihood of pregnancy remains the same, which previously occurred only when transferring two or more embryos. At the same time, the risk of becoming pregnant with five is completely eliminated.

As a rule, after genetic preimplantation testing, only one embryo is transferred to a woman. A genetic test allows you to screen out embryos with the “wrong” number of chromosomes and hereditary diseases – for example, cystic fibrosis and hemophilia. All this reduces the likelihood of a miscarriage and increases the chances of having a healthy baby.

Danger number 3: The risk of intra-abdominal bleeding that may accompany ovum collection

Fortunately, the likelihood of complications is very low – no higher than 1.4%. You can reduce the risk if, after a puncture, do not let the woman go home immediately, and watch her condition for several hours. This will allow you to identify and correct possible problems in time.

Danger number 4: Ectopic pregnancy

The embryo in the nutrient medium is transferred to the uterus under the strict control of ultrasound. Within 1-2 days, it should be implanted in the uterine wall. However, sometimes, in very rare cases, the embryo does not find a place in the uterus, and together with the outflow of fluid it may end up in the lumen of the fallopian tube and implant there – this is how an ectopic pregnancy occurs. That is why doctors carefully monitor each IVF at all stages of the procedure, including after embryo transfer.

Can a woman preparing for IVF reduce health risks?

“Objectively, the risks of IVF performed in a good clinic are not so great, ” said Lyubov Izmaylova, reproductologist, member of the European (ESHRE) and Russian Human Reproduction Associations (RARCH) . “As I tell my patients:” The main risk of IVF is pregnancy.”

You can increase the chance of IVF success if:

lead a healthy lifestyle – you need to ensure proper nutrition, eliminate smoking and alcohol;
go through all the tests and examinations recommended by the doctor – this will help identify problems that can either interfere with pregnancy or complicate it. In this case, the doctor must clearly explain why he prescribes this or that examination;

speak openly and honestly with a doctor – it is very important not to hide any information about the state of your health and the health of your loved ones. It is important to talk about all the diseases, bad habits, medical and cosmetic procedures that a woman does outside the clinic.

“Suppose a patient read somewhere that before hiring an egg, it would be useful to do hirudotherapy. But in the saliva of leeches there is a substance hirudin, which slows down blood coagulation, – Lyubov Vladimirovna gives an example. “ If the patient does not warn the doctor about visiting the hirudotherapy, there will be a risk of intra-abdominal bleeding, which will be extremely difficult to stop.”

Everything else depends on the skills and knowledge of the doctor. The best thing a patient can do is to trust a doctor and follow all his recommendations. The better the understanding between the doctor and the patient, the higher the chance of success.

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