The main risk of IVF is pregnancy

Oncopathology and IVF: is there a connection?

There are always a lot of rumors around the health of famous people, but these rumors are not always true. For example, the media sometimes hint that the cancer of the Russian actress Anastasia Zavorotnyuk provoked IVF. Together with the doctors of the ART-IVF clinic and an oncologist, the staff of the PR BAR agency 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, which is resorted to if other ways to conceive a child have not helped. IVF helps many infertile couples around the world become parents: over 40 years of existence, more than 10 million babies have been born thanks to the method.

Although children born as a result of IVF are often called "test tube babies", in fact, only fertilization takes place outside the body of the expectant mother. Then the embryo is transferred to the uterus. The future baby grows, develops and is born in the same way as all other babies conceived "naturally".

Does IVF really help to become a mom?

The probability of getting pregnant as a result of the IVF procedure is quite high. According to Elena Kalinina, MD, laureate of the Russian Government Award, creator and head of the ART-IVF reproductive health clinic, women under 35 get pregnant on average in 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 gradually decrease. For example, women aged 40-42 get 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 increases to 65-70%.

Can IVF cause cancer?

Doctor of Medical Sciences, Professor, Head of the Department of New Medical Technologies of the A.F. Tsyba MRSC – branch of the Federal State Budgetary Institution "NMIC of Radiology" of the Ministry of Health of Russia, obstetrician-gynecologist and oncologist Marina Viktorovna Kiseleva is convinced: in order to reasonably answer this question, it is necessary to rely on randomized multicenter studies. And 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 getting cancer as a result of IVF is very low.

For example, experts from the Israeli Maccabi Health Service conducted a study that involved almost 90,000 women who became pregnant with IVF. Only 41 cases of ovarian cancer, 38 cases of endometrial cancer and 501 cases of breast cancer were registered in all participants of the study. That is, exactly as much as was found in women with a "natural" pregnancy.

Even more indicative is the situation in Sweden, 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 have gained access to data on the health status of all citizens. Including 1,800,000 women who used either ovulation stimulation or an IVF program to achieve pregnancy.

Data on the health of this group of women were compared with data on the health of 2,000,000 mothers who became pregnant without the use of assisted reproductive technologies. It turned out that women who used the IVF program suffer from 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 even before pregnancy.

Where, then, did the rumor about the connection between IVF and cancer come from?

In vitro fertilization often attracts media attention – which is not surprising, because at least 50 million couples worldwide suffer from infertility. Let's see why, then, the media 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 #1: there are many scientific publications about the connection between IVF and cancer. Doctors and scientists are trying to make IVF as safe as possible to avoid the slightest risk for expectant mothers. All potential dangers associated with in vitro fertilization are studied literally "under a microscope" – even if the risks are small, they are carefully checked. As a result of the verification, scientific articles appear, the appearance of which is reacted to by the media – as a result, a lot of attention is drawn to the problem, but the problem itself is discussed one-sidedly.

Here is an example. According to one of the IVF protocols, hormonal medications are prescribed to expectant mothers at the preparation stage: this triggers the maturation of several eggs at once and increases the chances that there will be a perfectly healthy one among the resulting embryos. 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 during IVF can provoke breast cancer – and this was immediately reported in the media.

However, a thorough check showed that hormonal drugs used in IVF cannot cause breast cancer. All these drugs are capable of is to increase the level of female hormones. Sometimes an increase in hormonal levels can accelerate the development of an existing oncological disease, which a woman did not even suspect. "This is also why doctors conduct a very thorough and detailed examination of the patient before the IVF procedure," notes Elena Kalinina. – This allows you to detect the disease and minimize the risks"

But this is not so interesting and scandalous – so this time the media remained silent. As a result, everyone learned about the risk, but only doctors and scientists learned that there was no danger.

Reason #2: People are interested in the life of celebrities. We are interested in all the details of the idols' lives, including their state of health. Therefore, if a young and beautiful actress or singer falls ill, journalists begin to look for the causes of her illness. And since the ECO – method is quite well-known, it often undeservedly falls into the spotlight.

"As a good example, we can cite an attempt to link IVF and brain cancer – glioblastoma. Scientists have no evidence that this very rare tumor is associated with IVF. At the same time, coincidentally, tumors were found in both Jeanne Friske and Anastasia Zavorotnyuk. – Marina Viktorovna Kiseleva comments. – And since it is known that both stars were preparing for IVF, it is tempting to link these two circumstances. But then what about the fact that opera singer Dmitry Hvorostovsky, humorist Mikhail Zadornov and pianist Mikhail Kogan died of brain cancer? As you know, male celebrities certainly didn't do IVF."

Reason #3: Pregnancy and cancer may indeed be related. At the same time, it does not 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 pregnancy. During this period, changes in the body can really occur that can trigger the development of oncological diseases. – says Elena Andreevna Kalinina. – At the same time, pregnancy itself does not cause cancer and does not increase the risks of its occurrence. As a rule, problems arise in women who have suffered from the disease even before conception. For example, pregnancy can provoke the deterioration of the same glioblastoma. But this does not mean that IVF or pregnancy lead to this disease!"

What are the real risks of IVF?

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

We asked Elena Kalinina about the real risks of IVF. She spoke about three objectively existing problems.

Danger No. 1: Ovarian hyperstimulation syndrome. This is an individual reaction to hormonal drugs, as a result of which many more eggs mature at the same time than is sometimes 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 stimulation, the woman should be carefully examined, and the stimulation itself should be carried out under strict medical supervision.

Danger #2: Multiple pregnancies. In the 90s, when it was not yet possible to preserve "extra" embryos in our country, a woman could transfer all viable embryos – and then pregnancy with triplets, fours and even fives often occurred. This complicated the course of pregnancy, led to premature birth and other problems.

According to clinical guidelines, nowadays doctors transfer no more than two embryos into the uterus. It is forbidden to transfer more – this is explicitly stipulated in the order of the Ministry of Health No. 107n, regulating the work of reproductologists in our country.

Over the past years, the level of modern embryological laboratories has grown very much. If today reproductologists transfer only one embryo, the probability of pregnancy remains the same, which previously occurred only when transferring two or more embryos. At the same time, the risk of getting pregnant with five can be 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 with hereditary diseases – for example, with cystic fibrosis and hemophilia. All this reduces the likelihood of miscarriage and increases the chances of carrying a healthy baby.

Danger #3: The risk of intra-abdominal bleeding that may accompany egg collection. Fortunately, the probability of complications is very low – no higher than 1.4%. You can reduce the risk if you do not let the woman go home immediately after the puncture, but watch her condition for several hours. This will allow you to identify and correct possible problems in time.

Danger #4: Ectopic pregnancy. The embryo in the nutrient medium is transferred to the uterus under strict ultrasound control. Within 1-2 days, it should be implanted into 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 can end up in the lumen of the fallopian tube and be implanted there – this is how ectopic pregnancy occurs. That is why doctors carefully monitor each IVF at all stages of the procedure, including after embryo transfer – this allows you to help the patient in time.

Can a woman who is preparing for IVF reduce the health risks?

"Objectively, the risks of IVF, which is carried out in a good clinic, are not so great," notes Lyubov Vladimirovna Izmailova, a reproductologist, a member of the European (ESHRE) and Russian Associations of Human Reproduction (RARCH). - As I say to my patients: "The main risk of IVF is pregnancy."

IVF helps to increase the chance of success:

• to 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 to identify problems that can either interfere with pregnancy or complicate it. At the same time, the doctor must clearly explain why he prescribes this or that examination talking openly and honestly with a doctor 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 tell about all diseases, bad habits, medical and cosmetic procedures that a woman does outside the clinic.

"Suppose the patient read somewhere that it would be useful to do hirudotherapy before taking an egg. But in the saliva of leeches there is a substance called girudin, which slows down blood clotting – Lyubov Vladimirovna gives an example. – If the patient does not warn the doctor about visiting a hirudotherapist, 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 the doctor and follow all his recommendations. The better the mutual understanding between the doctor and the patient, the higher the chance of success.

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