Older IVF patients, cancer and parenting

December 10, 2010Carole 4 Comments »

The sad news that Elizabeth Edwards, estranged wife of politician John Edwards,  died this week at the age of 61 after a long struggle with cancer made me reflect on several issues related to IVF. Mrs. Edwards family life was complicated in that she and John had four children, two early in the marriage  and two more late in the marriage with the help of IVF.  Perhaps precipitated by the tragic death of her 16 year old son, the Edwards decided to have two more children who were born when Elizabeth was 48 and 50. The younger children were conceived through the use of IVF and, because of her advanced maternal age, likely egg donation.

Elizabeth Edwards was diagnosed at the age of 55 with a breast tumor which was successfully treated initially, but the cancer returned and spread to her bones and other organs including her liver, finally claiming her life six years after diagnosis.

Two questions arise.  First, did IVF treatment increase her risk of cancer?

The concern regarding IVF treatment and cancer arises from the use of ovarian stimulation medications to raise the levels of estrogen and progesterone well above normal levels, which may persist even during pregnancies achieved with IVF. Some cancer cells are estrogen sensitive and may be stimulated by high estrogen levels.

From time to time, various studies have been published which pointed to a possible increased risk of reproductive cancers among women who used IVF. Other studies showed no elevated risks. Most studies on IVF patients have been inadequate because too few patients are studied for two short a time period after IVF.

Longer term large population studies are difficult to do in the US because there is no mandated reporting of patient health care data to the government.  Other nations like Sweden have national registries to track diseases which makes long term outcome studies over a large population possible.  We would probably consider collection of our personal health care information by large national databases an unacceptable intrusion of our medical privacy. But without this sort of reporting infrastructure, it is difficult, if not impossible to do large health outcome studies.

Two Swedish studies, published in 2006 and 2010 by different groups of researchers tracked thousands of Swedish women who had IVF and compared their incidence of cancer with women in the general population.  Neither study found any increased rate of cancer after IVF. Interestingly, some women had an increased incidence of  ovarian cancer before IVF, suggesting that similar ovarian dysfunction leading to ovarian cancer may also play a role in infertility or that more women with ovarian cancer sought out IVF for fertility preservation.

The newest study was especially reassuring because data was collected over a long period of time (24 years between 1982-2006)  and a large number of women were in the study (24058 women who had conceived and given birth in the IVF treatment group and over 1 million women in the general population group). The average time after treatment that was monitored in the study was between 6-7 years. This time period was considered adequate because the scientists expected that this time period would be long enough to see a cancer inducing effect of transiently elevated hormones from ovarian stimulation.

Because Mrs. Edwards was 47 when she used IVF to conceive her third child, it is highly likely she used eggs from a younger donor. When donor eggs are used, the donor undergoes ovarian stimulation, not the recipient, so ovarian stimulation is unlikely to have played a role in causing her breast cancer. Mrs. Edwards openly discussed her use of IVF and by her successful example, promoted motherhood at advanced maternal age.

Regardless of whether we have IVF or not, we increase our risk of cancer simply by aging. As we age, our natural defenses against cancer diminish. Our immune system kills mutated or damaged cells everyday, preventing their proliferation to tumor stage. We are continually killing off problem cells before they become full blown cancer. The diagnosis of cancer may be more due to a failure of routine elimination of problem cells rather than the existence of some super cancer cell. As we get older, our immune systems become less effective, increasing our risk of all disease, including cancer. Simple aging and perhaps other unknown risk factors, but probably not IVF, caused Mrs. Edward’s cancer.

The CDC reported that the birth rate for women aged 40 to 44 jumped 4% in 2008, suggesting that more older moms are having kids, thanks to IVF. Which raises my next question.  Are children conceived to middle-aged parents more likely to lose one or both parents in childhood? In the article, What Happens to Elizabeth Edwards’ Kids Now that She’s Gone?, the author treads lightly on this topic, concluding that Elizabeth’s  kids will probably be alright because their father is still alive and actively parenting their kids.

I am pro-choice about reproductive freedom because I don’t think that I know what’s best for any family except perhaps my own. Still, I wonder whether, by providing a technological solution to reproductive aging, we leap frog right over all the parenting issues that arise for older parents after the IVF is successful and the child is born. Will these older parents be healthy and vital long enough to give their kids the childhood they want and need?

© 2010, Carole. All rights reserved.

4 Responses to this entry

  • amr azim Says:

    Thank you for clarifying the unlikely relationship between Mrs Edwards fertility treatment and breast cancer. Few years ago I thought that media reports linking her fertility treatment-likely oocyte donation was inaccurate and lack scientific evidence. We also do not know if her cancer was estrogen receptor positive or not although estrogen receptor negative cancer can also respond indirectly to estrogen. The studies you pointed to also point to the fact that pregnancy itself-which IVF may help to establish, reduces the risk for breast cancer and other cancers, a fact that is commonly ignored. Finally women that are diagnosed with breast cancer and sought fertility preservation through ovarian stimulation and embryo freezing does not appear to have an increased risk for recurrence at least on the intermediate terms-2 year follow up http://preservationoffertility.org/2010/07/30/breast-cancer-and-ovarian-stimulation/

  • Carole Says:

    Thanks for your comments and the link to additional information on fertility preservation/cancer treatment.

  • amr azim Says:

    Thank you for the great information you disseminate about assisted conception especially fertility preservation in cancer patients.

  • Carole Says:

    You are welcome. Have you seen the Oncofertility Consortiuum website info? They have a wealth of resources/info on fertility preservation for patients, researchers and physicians. Here’s the link http://oncofertility.northwestern.edu/

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