Ovarian cancer ranks 5th in cancer cases among women. Use of fertility medication has been hypothesized to increase the risk of several cancers types, including ovarian. Latest scientific data does not show direct correlation between fertility treatment and ovarian cancer. Also, newly-developed fertility treatments further diminishes the possibility of such cancers developing.
What is Ovarian Cancer?
Ovarian cancer mainly develops in older women and approximately half of the women who are diagnosed with ovarian cancer are 63 years or older. Ovarian cancer is a complex, multifactorial disease that, unfortunately, is often detected at a late stage and unless detected, spreads within the pelvis and abdomen. At this late stage, ovarian cancer is more difficult to treat and is frequently fatal. Early-stage ovarian cancer, in which the disease is confined to the ovary, is more likely to be treated successfully either with chemotherapy or surgery.
There are three types of tumors that cause ovarian cancer:
1. Epithelial tumors, which start in the thin layer of tissue that covers the outside of the ovaries. Approximately 90% of ovarian cancers are epithelial tumors.
2. Stromal tumors. This type of cancer initiates in the ovarian tissue that contains hormone-producing cells. These tumors are usually diagnosed early and comprise to about 7% of ovarian cancers
3. Germ cell tumors, which are found in the oocyte producing cells. These are rare ovarian cancers, which occur mostly in younger women.
Fertility Medication and Ovarian Cancer
Fertility medication promotes maturation of multiple follicles and, consequently, multiple ovulations by increasing gonadotropin levels. These medication are utilised alone or in combination depending on the cause of infertility and the treatment protocol followed.
Results from more recent studies have been primarily reassuring; most studies observed no association between fertility drug use and overall ovarian cancer risk (Kurta et al, 2012). Impact of fertility drug treatment on certain subgroups, including long-term fertility drug users, women who remain nulligravid and borderline ovarian tumors, is not yet clear (Diergaarde and Kurta, 2014).
Ever use of fertility medication was not significantly associated with ovarian cancer risk within the total HOPE population or among women who reported seeking medical attention for infertility. Risk did not differ significantly according to duration of use or type of fertility drug. However, we did observe a statistically significant increased risk of ovarian cancer for ever use of fertility drugs among women who, despite seeking medical attention for problems getting pregnant, remained nulligravid (Rossing et al, 2004; Jordan et al, 2009; Kurta et al, 2014).
Fertility Treatment for patients with Ovarian Cancer
One of the major concerns for women with a history of cancer is infertility issue after malignancy treatments (Partridge et al, 2004). Development of fertility preservation strategies helps the patients in having adequate options before experiencing aggressive treatments. There are a variety of available strategies with aim to preserve female fertility. Such strategies are applied based on patient’s age and status as well as the risk of ovarian involvement.
Cryopreservation of embryo is the most relevant and well-established option for fertility preservation and was the only method endorsed by the ASRM. Embryo cryopreservation is considered the best option that can be offered to post-pubertal women who desire fertility preservation, especially for those who are mature and have enough time prior to onset of aggressive treatments and have a partner or sperm donor as well (Rajabi et al, 2018).
Cryopreservation of oocyte is another option especially for those women who are single and are not pleasant to have sperm donation. This option has greatly increased in women requiring in preserving their fertility. The technological advances (i.e.vitrification) have allowed comparable results of survival and live births to embryo cryopreservation (Fisch and Abir, 2018).
Another alternative for fertility preservation in women with oncological and non- oncological diseases is ovarian tissue cryopreservation. Some studies have shown that immature oocytes within primordial follicles are more resistant to cryopreservation damage and this method has this potential to be a suitable option (Nugent et al, 1997). However, the main question and concern regarding this technique is how to activate quiescent follicle after freezing and thawing.
At Mediterranean Fertility Institute, we are always on the forefront of current scientific information from pharmaceutical companies regarding the medication we prescribe to our patients. We try with our own extensive statistical data to contribute in the scientific progress with responsibility to each patient and the society.