There have been more newspaper headlines than usual about IVF in the last two weeks. A recent Daily Mail article published a report on a scientific paper from the USA concerning the effect the dose of ovarian stimulation during treatment has on the chances of having a baby. This was a very large analysis of more than 650,000 IVF treatment cycles carried out in the USA and it came up with hugely important findings which were of no surprise to me but have caused a stir in the IVF community. It clearly shows that IVF live birth rates reduce significantly with increased doses of follicle stimulating hormone (FSH) injections given during IVF treatment regardless of number of eggs collected. Studies have previously shown that the quality of eggs and embryos can be compromised if we collect high number of eggs and that babies conceived in such cycles are at increased risk of being premature or low birth weight. This is the first time however that it has been convincingly demonstrated that the higher the stimulatory dose of FSH, the lower the chance of success. There is now no case to be made for creating high numbers of eggs by overstimulating the ovaries. It can damage eggs, reduce success rates, cause small babies and endanger women's health. The scientific and economic case for Mild and more Natural IVF treatment is to me unanswerable.
Last week, we also saw headlines in virtually all newspapers about increased ovarian cancer risk in women who have undergone IVF with claims that women who have been treated are a third more likely to get ovarian cancer. This large UK study which scrutinised the records of over 255,000 women who had received Assisted Conception treatment in whom 386 ovarian cancers were identified was presented at the large American Fertility Conference (ASRM) in Baltimore and full details have yet to emerge. However the study has high pedigree as it is based on the large MRC study of ovarian cancer screening which has linked its database with that of the HFEA. The study found that the younger a woman was when she began ART treatment, the greater her chances were of developing ovarian cancer, and that the risk of developing cancer was greatest within the first three years of treatment. The causal link is not clearly established in the UK study and we will have to see if these cancers are of the more aggressive type or not. Any ovarian cancer should be a cause for concern and we need further studies to confirm the findings. A large Dutch study in 2011 concluded that ovarian stimulation may increase the risk of ovarian malignancies, especially borderline ovarian tumours.
It has been recognised for some time that women with infertility problems are at a slightly increased risk of developing ovarian cancer but evidence is building up that the addition of ovarian stimulation in IVF treatment increases that risk. In the UK, we need information about stimulation and other drugs and dosages given to women during IVF treatment to understand if there is any link between drugs, high hormone levels and cancer risk. Unfortunately the UK regulator of IVF, Human Fertilisation Embryology Authority does not collect or monitor information about drugs, dosages and detailed protocols in IVF so at the moment we have no way of finding out if women are put at future health risk with drugs and interventions
Different dosages of drugs are used by different clinics, with some clinics even using 600 IU of FSH per day which is very high. Some clinics also give "off label" medication during the implantation phase and early pregnancy. It is concerning that there is no regulation as to what drugs are given and in what dosages.
We need to act now to protect the health and safety of women in IVF. The Parliament must intervene to protect the welfare of women in IVF.