Q: Are there any studies on the impact of fertility drugs on health? How safe is it to do multiple cycles? When should you decide to stop doing IVF because of possible side effects?
A: Yes, there are studies on the impact of fertility drugs on health. Many of these reports have conflicting results. A few things can be said. The long term use of clomiphene citrate (twelve months of use over a lifetime) may result in an increased chance of developing ovarian cancer later in life. The use of tamoxifen for the purpose of inducing ovulation may result in a higher incidence of congenital abnormalities. The use of fertility drugs does not hasten the onset of the menopause. New information is reported all the time. Even though we currently believe that fertility drugs are safe, there is always the possibility that additional risks will be reported in the future.
Having said that, the decision to use fertility drugs should always balance the potential benefits against the risks of use. The goal of treatment is to use as few drugs as possible for as few cycles as possible to achieve the purpose of having a healthy baby. We know that 83 percent of the pregnancies that will occur with any treatment regimen will occur within three cycles of treatment, so there is no reason to continue doing the same thing for more than three or four cycles. There is no reason to continue to incur the potential risk of using a drug if there is little or no benefit to its use. Each failed cycle of treatment needs to be evaluated individually with your physician to decide what changes can be made to improve the outcome and how long each treatment should be continued.
IVF is like any other treatment. Most of the pregnancies will occur within three cycles of treatment, so unless changes can be made to improve the outcome, it doesn’t usually make sense to do the exact same thing again and again. The major risks of IVF, ovarian hyperstimulation syndrome and multiple pregnancy, are limited to the cycle of treatment. So each cycle you do IVF, you are either hyperstimulated or not and you are either pregnant with a multiple pregnancy or not. The next cycle you do IVF, you have the same risk, no more, no less. If you are hyperstimulated and are not pregnant, the hyperstimulation goes away with your menstrual period. If you are hyperstimulated and pregnant, the hyperstimulation may persist for the first few weeks of pregnancy. The decision of when to stop IVF is individual and should be made with your physician. Remember, it is a risk-to-benefit ratio.
Q: I have cervical factor infertility and have never had a positive pregnancy test in five years of unprotected sex, and we had one insemination with injectables that failed. Now that we have adopted, I do not want to get pregnant. My husband and I are wondering if we should use birth control. What do you think?
A: Absolutely, you should use contraception if you do not want to become pregnant. Otherwise you may be in for an unwelcome surprise as unlikely as it seems. Cervical factor is a relative, not an absolute barrier to fertility, so women with cervical factor do occasionally become pregnant on their own without any treatment even after long periods of infertility. Inseminations should overcome cervical factor because the insemination bypasses the cervix, but you did only one cycle and the chance of a pregnancy in one cycle of injectables plus inseminations is no more than 30 percent even if you are at your peak fertility (thirty years old or younger and with no other infertility problems).
Additionally, anyone who works in the field of infertility can recount instances where couples adopted and then unexpectedly conceived. Is it because these couples were no longer so focused on their infertility and associated treatment so their focus changed to the needs of the new member of the family (and they relaxed)? Is it that the arrival of the new addition has been a stress reliever? We know that infertility is very stressful and stress can be a negative factor when a couple is trying to conceive. Is it just coincidence? I don’t think anyone can say why some women conceive spontaneously very quickly after adopting a child, but they do, so be careful.
Fertile Thoughts is published monthly. Each column features a real question from a reader, and we invite other readers to respond with their thoughts and insights by posting comments. If you have a question for Dr. Carlene Elsner, please send it to her care of the editor at firstname.lastname@example.org. Your question will be kept in the strictest of confidence.
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