da Vinci Robotic Microsurgical Tubal Reversal

For women who wish to have a tubal reversal, we offer state of the art Robotic Assisted Microsurgical tubal reversal using the most advanced surgical tools available today, and are able to still do this at a very affordable cost.  Without question, having a tubal reversal performed laparoscopically is associated with a much faster recovery, less pain, and less internal scarring, limiting the chance of damaging the fragile fallopian tubes.  However few surgeons are can do this procedure laparoscopically, and for those that do, because of the limitation of standard laparoscopy, sacrifices have to be made in the surgical technique compared to the older standard of having an open incision and using a surgical microscope.

By using the da Vinci Robotic system, we are able to provide you with the best of both worlds, performing a true microsurgical tubal reversal technique, while doing this as an outpatient procedure with a fast recovery and less chance of internal scarring that can affect the newly opened tubes.

FAQ

How is a tubal reversal performed?

There are three methods by which a tubal reversal can be performed.  These include the old-fashioned “open” method, standard laparoscopy, and Robotic Assisted Microsurgical techniques.  In the past, patients who underwent the “open” method had a 3-4” incision in their lower abdomen to reach the uterus and tubes.  Microscopes were then used to open the tubes and sew them back together.  This method allowed precise surgery to be performed, but by using an open incision, patients had a much longer recovery, usually requiring a week or more from work.  The open incision also inherently causes scar tissue, which we just hoped did not affect the tubes.    Through laparoscopy, patient recovery is much faster, and less scarring inside occurs.  The drawback of this procedure is that due to limitations in the instruments, even the best surgeons cannot perform as precise of a tube repair as they could previously do under a microscope by hand.   This could possibly sacrifice the success of the surgery.   With the use of the da Vinci Robotic surgical system, the best of both worlds are combined, allowing a true microsurgical repair to be done, with a quick recovery and low chance of forming internal scar tissue.   Typically one small incision in the belly button (10mm wide), and three other small incisions (7mm wide) are made.   This procedure is by far the best for the patient, providing several advantages to ensure that you have the best possible outcome

Who is a good candidate for a tubal reversal?

Tubal reversal success is dependent on the method in which the tubal was first performed.   The highest success comes with those that have had “clips” or “rings” placed on the tubes.   These methods damage the tubes the least.   In some cases, a segment of tube is removed, most commonly done right after a delivery.  These methods are termed a “Pomeroy” or “Parkland” method, and in most cases are reversible.   Tubes that have been “burned” are often overly damaged and may not be reversible, though each case is different.   It is helpful to obtain a copy of the surgical operative report to better determine if a tubal reversal could be performed

Fertility is very dependent on the age of the woman.   A tubal reversal is most successful if a woman is 35 years of age or less.   For women who are over 37 years of age, studies have shown that a tubal reversal may not be the most cost effective therapy for trying to conceive.  These patients are better suited to go directly to IVF.

Is a tubal reversal covered by insurance?

In nearly all cases, insurance does not cover reversal of sterilization.    Performing a tubal reversal and trying to get insurance to cover the costs is considered insurance fraud and puts the patient and physician at legal risk.

Why don’t you perform this at an outpatient surgery center?

We only perform Robotic Assisted Microsurgical Tubal Reversals at an accredited fully staffed hospital.   Freestanding outpatient surgical centers do not offer the use of the advanced da Vinci Robotic Surgical System.  We also feel that it is the safest for patients to have surgery in a hospital.   The procedures are all very safe, but in the event that any unforeseen complications would arise, a hospital setting offers you the full resources and staff to properly care for you.   If complications occur in a surgical center, you must be transferred by an ambulance to a hospital to receive the proper care, possibly wasting valuable time.   Having your surgery performed in a hospital is always in your best interest.

Maybe the Best IVF Value in the Country

Have you thought about in vitro fertilization but are concerned about the investment? The Florida Institute for Reproductive Medicine offers a package of three fresh IVF cycles as well as the transfer of all cryopreserved embryos.  This package includes intracytoplasmic sperm injection as well as assisted hatching if indicated, and it includes cryopreservation of embryos if available.  Completion of all fresh and cryo IVF cycles must occur within a sixteen month period.  Transfer of all cryopreserved embryos must occur before another fresh IVF cycle is begun.  Cost for this package is $14,500, not including the cost of fertility medications.  Medication costs range from $2,600 to $4,000 depending on patient’s age, weight and ovulatory status.  There are no refunds whether pregnancy occurs before three completed fresh cycles or before completion of all cryopreserved embryos.

Although this program is available to anyone, this program is ideal for patients with a lower than optimal probability of success. When one considers the high pregnancy rates at the Florida Institute for Reproductive Medicine for both fresh and frozen embryos (http://www.cdc.gov/art) we believe this package may represent the best IVF values in the country.

Paying For Infertility Care

Diagnosis and treatment of infertility is expensive.  Unfortunately most insurance companies continue to look at infertility as an elective part of health care – frequently not covering diagnostic testing or treatment.  Infertility costs for the most common treatment (i.e. ovulation induction with washed intrauterine insemination) ranges between $500 – $600 at the Florida Institute for Reproductive Medicine.  Costs for in vitro fertilization, range between $10,000 – $11,000.  In general, we want to try the simplest therapy that has a good chance of working, give it a good try; and if it is not successful, move on to more aggressive options.

The Florida Institute for Reproductive Medicine has partnered with a finance company to provide financing of infertility care.  Rates as low as 3.99% are available for individuals with good credit.  Loans from $2,000-$40,000 are available with payments ranging from 24-84 months.  No up-front payments are needed.  There are no pre-payment penalties.  The Florida Institute for Reproductive Medicine has an assistance program for our IVF patients who have no insurance coverage and who qualify based on income, whereby up to $2,000 worth of medications will be provided.  We have a 10% discount for all active military patients.

Some more creative options couples may consider include:

• Joining a drug study:  At times, we at the Florida Institute for Reproductive Medicine have been asked to participate in drug studies.  As part of the compensation for participation, patients may receive anything from free medications to an entire IVF cycle.  Many of these studies have specific requirements for participation.  Check with us to see if there are available studies and if you may qualify for them.
• Donating eggs:  At the Florida Institute for Reproductive Medicine we have an active donor egg IVF program.  Donors are compensated $3,000 for participating in an egg donation cycle.  Donors are allowed to donate up to four times, potentially earning $12,000 – enough for their own IVF cycle.  Check with our donor egg coordinator to see if you meet donor requirements.
• Shop for money back guarantees:  Some programs will offer a money back guarantee for IVF cycles if they are not successful.  Typically centers charge a premium for the IVF cycle in return for the guarantee.  Generally these programs have specific requirements for participation.  For couples who would be out of options if their IVF cycle did not work, this allows them to potentially participate in other treatment options like donor egg IVF or adoption.

Above all, do your homework.  At the Florida Institute for Reproductive Medicine we have always strived to offer the best treatment value for all our services.  Our pregnancy rates have been consistently amongst the highest in the country.  Costs for all our services at the Florida Institute for Reproductive Medicine typically range 25-30% less than national averages.

Egg Freezing

The ability to freeze a human egg offers at least two important options for women: fertility preservation for women faced with potentially sterilizing therapies and individuals postponing childbearing, as well as couples requiring in vitro fertilization (IVF) who are ethically opposed to freezing (pre)embryos.  Being able to freeze eggs also allows for the establishment of egg banks, greatly improving the efficiency and lowering costs for donor egg IVF.

We have been able to freeze (pre)embryos since the early 80’s, a technique that is routinely performed in most reproductive medicine programs.  Freezing an unfertilized egg is much more difficult because of the large size and water content, i.e. as the egg cools ice crystals develop which can damage the working components known as organelles.  When a (pre)embryo is frozen, the essential task of these organelles has already been performed.

The first pregnancy from a frozen egg was achieved by Dr. Chen in 1986.  Following this pregnancy there were no other pregnancies until the early 90’s.  With the abolishment of (pre)embryo freezing by the Italian government there was a resurgence in egg freezing technology.  Dr. Borini and others refined the protocols for egg freezing, and with the advent of intracytoplasmic sperm injection (ICSI), whereby a single sperm could be injected into an egg the efficiency of egg freezing increased.  Dr. Dunsong Yang, the head of embryology at the Florida Institute for Reproductive Medicine, was one of the early pioneers in refining the egg freezing protocol, greatly improving its efficiency.

The Florida Institute for Reproductive Medicine has one of the largest experiences with egg freezing in the nation with over 63 babies born, including the first baby born in the world to a cancer patient who froze her eggs prior to chemotherapy.  Currently we are seeing pregnancy efficiencies of approximately 10 eggs equating with an ongoing pregnancy for egg donors 35 years or less and approximately 14 mature eggs for those 36-38 years of age.  In general, we do not freeze eggs beyond 38 because of the high percentage of abnormal eggs.  Our work on egg freezing has been chronicled in People, Self, Pink, Conceive, and Woman magazines as well as on CBS, NBC, BBC News, and the Today Show.

To date, in the world there are approximately 3,000 babies born from frozen eggs.  Health data on these infants continues to be very reassuring.  Until, however, high numbers of these children have reached adulthood and reproduced, the absolute safety of this technology cannot be asserted.  For that reason egg cryopreservation is still recommended to be done under an IRB (institutional review board) approved protocol.  At the Florida Institute for Reproductive Medicine we keep yearly surveys of our cryo egg births through annual questionnaires to parents and pediatricians.  Costs for egg freezing at the Florida Institute for Reproductive Medicine mimic those of an IVF cycle, i.e. approximately $10,500.

We will store eggs at no charge for a period of five years, after that time there is an annual storage fee of $400.  For our cancer patients seeking fertility preservation, we have been able to get medicines donated by the Ferring drug company, saving patients approximately $3500.  The longest an individual has stored eggs to date and had a successful pregnancy is 6 ½ years.  We do not believe there likely is a shelf life to frozen eggs.

Post Tubal Ligation Tubal Reanastomosis Versus In Vitro Fertilization

Approximately 10% of women who undergo tubal ligation subsequently wish to have another child – the most common reason being a new male partner who has never fathered children.  Tubal ligation involves the interruption of the tube, typically in the mid portion or rarely resection of the distal end of the tube.  All tubal ligation patients have the option of in vitro fertilization (IVF), assuming they have good ovarian reserve, i.e. a reasonable number of good quality eggs left in their ovaries.  Ovarian reserve can be checked by a variety of means, the most accurate being an ultrasound count of follicles in the ovary along with a blood test known as antimullerian hormone level.

To be a candidate for tubal reconstructive surgery it must be ascertained that the patient has sufficient healthy remaining tube and that the distal working end of the tube has not been removed or damaged.  If a tubal ligation has been performed using cautery often extensive tube damage has occurred.  These individuals in general are not good candidates for surgery.  Prior to considering tubal surgery a semen analysis to rule out a severe male factor should be performed.  If a severe male factor is found, IVF using intracytoplasmic sperm injection (ICSI) is likely to be the best option.

If the female partner is older than 35, despite good ovarian reserve she is likely to have an increased proportion of poor quality eggs, often resulting in a significant delay to conception.  For the older patient IVF is likely to be the preferable option.  If ovarian reserve is poor, donor egg in vitro fertilization is the most realistic option.  If the female partner is 35 years or less with good ovarian reserve pregnancy rates of approximately 70% can be expected with surgery, comparable to cumulative pregnancy rates with IVF.

At the Florida Institute for Reproductive Medicine tubal reanastomosis is being performed on an outpatient basis with the use of the da Vinci robot allowing individuals to return to work typically within one to three days.  Surgery is associated with a significant increase in the risk of an ectopic pregnancy, i.e. a pregnancy getting “stuck” in the tube.  This condition can be serious requiring emergent surgery.  If a couple decides they only want a single pregnancy the issue of future contraception must be addressed.   At the Florida Institute for Reproductive Medicine, using the robotic laparoscopic approach we are able to offer this surgery at a cost of $6,750 (cost for an average IVF cycle is $11,000).  The primary disadvantage of IVF is a high multiple pregnancy rate.  For individuals less than 38 years of age multiple pregnancy rates range from 20-40%, 98% of these being twins.  While the great majority of twins do very well there is an increased risk of morbidity and mortality.  Almost all multiple pregnancies are delivered by cesarean section.  The issue of a multiple pregnancy can be avoided by electing to transfer a single embryo.  For couples who are ethically opposed to IVF because of the issue of freezing (pre)embryos, this can be avoided through egg freezing.  Because of the disadvantages associated with surgery approximately 9 out of 10 couples at our center are electing IVF as opposed to surgery.  With the advent of the low cost outpatient robotic approach, we believe this ratio will decrease.

An Explanation of IVF Success Rates

Following passage of the Wyden bill in 1991, fertility programs in the United States were required to report their in vitro fertilization (IVF) pregnancy data to the Centers for Disease Control (CDC). This bill was intended to give the consumer a means of evaluating a particular IVF program. While the majority of programs in this country do report some do not. The penalty for not reporting is minimal – these programs are simply listed by the CDC as non-reporting. Reporting programs are subject to unannounced audits by qualified embryologists to verify data. At the Florida Institute for Reproductive Medicine over the last 21 years, we have been audited on two occasions and have passed both. A program not reporting their data to the CDC can report whatever data they wish, knowing they are not going to be audited. For that reason, it is wise to avoid any non-reporting program. To check and see if a program is a reporting program, check the website www.cdc.gov/art/art2010 (/art2009, /art2008, etc). I would suggest checking for at least the last three to four years as some clinics may report their data only when it is favorable.

When evaluating IVF success rates, it is important to look at live pregnancies from both fresh and frozen cycles. Some programs may report clinical or chemical pregnancy rates, approximately 5-20% of these pregnancies will end in miscarriage. Probably the biggest difference in cumulative pregnancy rates between programs is the difference with cryopreserved embryos. At the Florida Institute for Reproductive Medicine our fresh and frozen embryos have consistently been in the top ten percentile of programs nationwide. When evaluating pregnancy rates, it is also very important to look at the average number of embryos transferred. Many programs reporting very high pregnancy rates are achieving these results by transferring inappropriately high numbers of embryos. This practice inevitably results in a high percentage of multiple pregnancies. Multiple pregnancies are associated with increased morbidity and mortality to both fetuses and mother. At the Florida Institute for Reproductive Medicine for most individuals 38 years or less we are transferring two day 5/6 blastocyst embryos. For individuals less than 35 who are in a very good prognostic category we frequently will transfer a single blastocyst. For women older than 38 we may transfer up to three day 5/6 blastocyst embryos.

IVF Value

Costs in the U.S. for in vitro fertilization typically range from $10,000 to $18,000 inclusive of medications.  Added potential costs include intracytoplasmic sperm injection (severe male factor) $500 – $2000, assisted hatching (patients 38 years and older) $500 – $2000, as well as costs associated with cryopreservation of embryos $500 – $2000.  Costs for subsequent thawing and transferring of cryopreserved embryos typically range between $1000 and $3000.  Costs most often are not covered by insurance.  At the Florida Institute for Reproductive Medicine, our costs have always fallen around the lower end of these ranges.  We always strive to provide IVF at the lowest cost possible, making this therapy available to the greatest number of patients.

Infertility patients faced with in vitro fertilization are primarily interested in their chances of taking home a baby from all their IVF embryos.  Given the very real concern over multiple pregnancies, i.e. potential significant morbidity and mortality, along with the cost and social difficulties associated with a multiple pregnancy, limiting the number of embryos transferred is appropriate.  At the Florida Institute for Reproductive Medicine the majority of our patients are transferred no more than two embryos.   Additional embryos are cryopreserved.  This brings up the issue of pregnancy rates associated with fresh as well as cryopreserved embryos.  IVF programs practicing in the United States are required by law to report their pregnancy data to the CDC each year (http://www.cdc.gov/art/ARTReports.htm).  One of the greatest differences in IVF programs is their cryo embryo pregnancy rates.  Many programs have very poor results with cryopreserved embryos.  For younger patients, less than 35 years of age, who likely will have embryos to cryopreserve, this represents a big disadvantage.  Generally, fresh pregnancy rates will be somewhat higher in any program due to selection bias, i.e. when embryos are created, typically the embryologist will select the best looking embryos to transfer fresh, cryopreserving the remaining embryos.  At the Florida Institute for Reproductive Medicine our fresh and frozen pregnancy rates have been among the highest in the country.  Therefore, when trying to determine the value that a particular IVF program offers, it is important not only to take into consideration the cost, but also the pregnancy rates obtained from both fresh and frozen embryos.

A further consideration is the total number of embryos obtained.  This number will vary depending on the patient’s age/ovarian reserve as well as the stimulation protocol, retrieval, and laboratory efficiency.  At the Florida Institute for Reproductive Medicine, given the new and aggressive stimulation protocols used, the majority of our patients less than 35 years of age have embryos for at least one cryo IVF transfer, many have embryos available for a second cryo transfer.  Therefore, total reproductive potential is the sum of the fresh transfer plus all cryo IVF transfers.  Looking at the total reproductive potential in the context of IVF costs, we believe that the Florida Institute for Reproductive Medicine offers one of the greatest IVF values in the country.

Why Can’t I Have Another Baby?

Almost half of infertility occurs following an initial pregnancy that may have occurred soon after discontinuing contraception.  This problem, known as secondary infertility, is often overlooked or downplayed by physicians who see these patients as being fertile and are then reluctant to evaluate or treat.  Maternal age and the duration of secondary infertility are critical issues.

We know that women are born with a certain number of eggs – they never make any more eggs the rest of their life.  The number and quality of eggs declines as a function time, resulting in a significant decrease in pregnancy rates after age 35, and a drastic decrease after 38.  Infertility is defined as a lack of conception after one year of unprotected intercourse.  For individuals 35 years or older, most reproductive medicine specialists recommend initiation of a work-up after four to six months of trying.  Ultimately, again, remaining egg number and quality are the critical issues.

Evaluation for secondary infertility should be identical to that of primary infertility targeting those issues that are most suspect.  Almost 40% of all infertility is male related.  Even if a male has fathered a child, semen parameters can change drastically due to a variety of health changes including medical problems, surgeries, traumas, or infections.  A semen analysis will evaluate a male’s current fertility status.  If there has been a change in male partners, particularly if the new partner has not fathered children, certainly male factor may be the issue.  Almost 50% of infertility is female related, primarily ovulatory or anatomic problems.  While a female may have a history of regular ovulatory cycles prior to, her ovulatory pattern can change drastically following a pregnancy, especially if there has been a significant weight gain.  If prior pregnancy was delivered by cesarean section, adhesion scar formation certainly can occur and be associated with significant tube compromise.  Loss of weight will often bring about a return of regular ovulatory cycles.

If there has been a long time between the first pregnancy and initiation of a second pregnancy, certainly the issue of egg quality may be the problem, especially if mom is now over age 35.  Strategies to try and improve fertility due to an egg quality issue include superovulation (getting the patient to release multiple eggs) or in vitro fertilization (transferring more than one embryo back to the uterus).  If the initial pregnancy was delivered by cesarean section and especially if there was a history of infection, adhesions may be causing a tubal factor.  If there was retained placenta following delivery, uterine scarring can occur – hysteroscopy (outpatient surgery – scope is used to look into the uterine cavity) should be considered.  With a significant time delay before initiating a second pregnancy, conditions like endometriosis, the growth of endometrial tissue outside the uterine cavity, i.e. in the pelvis, may cause significant anatomic distortion.  Likewise, fibroid tumors that may have been small and clinically insignificant prior to pregnancy may now be large and compromising fallopian tubes or the uterine cavity.

In conclusion, secondary infertility is a very common problem.  Delaying evaluation and treatment is often associated with severely diminished chances for pregnancy.  Secondary infertility should be approached in an aggressive, targeted manner especially in the context of advanced maternal age.

Meet the Experts: A Family Building Expo

Saturday, November 19, 2011 8am – 11am, St. Luke’s Hospital Auditorium. Presented by Resolve, the National Infertility Association. Are you one of the 1 in 8 couples of childbearing age in the U.S. diagnosed with infertility? Are you interested in learning more about your family building options? This EXPO is for you. Door prizes include a free IVF cycle and other professional services. Cost: $10 per person / $15 per couple in advance or $15 per person / $20 per couple at the door. Register in advance at www.resolve.org/Jacksonvilleexpo.

Fertility Treatment and Ovarian Tumor Risk

Recent headlines have reported that IVF treatment is linked to ovarian tumors based on a recently published study. The findings are not different than was was reported over 10 years ago, and media coverage often misleads the public into making assumptions that may not be true. Many studies in the past have reported positive or no linkages with fertility treatment and ovarian stimulation and future risk of ovarian tumors. This study from the Netherlands was retrospective in nature, meaning that they started with women who had tumors, then looked to see what type of treatments they had. This type of study can possibly find causal linkages between a treatment and an outcome, but are in no way definitive as there are many biases that are introduced. You can breathe a sigh of relief that the study did find no link between IVF and ovarian cancer in a follow up of 15 years time. The only relationship was with possible “borderline” tumors, often called “low malignant potential” tumors. These are not invasive cancer and are not considered pre-cancer tumors, though they can grow like a tumor over time. The prognosis with this tumor is usually very good and tremendously different than with invasive ovarian cancer. Below is a blog from the American Fertility Association that helps to clarify a lot of this information.

Tumors of low malignant potential

Posted by Corey Whelan on Oct 27, 2011 with 1 Comments

http://www.theafa.org/blog/tumors-of-low-malignant-potential/

A new study out of the Netherlands and published in Human Reproduction is making the news today. It is entitled “Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort”. Reuters picked it up as “Fertility treatment raises tumor risk in study”.

It is of course understandable that The AFA’s phones have been ringing off the hook. Women are alarmed by this report. Briefly, I wanted to share a few facts about the study and urge you to please relax while you read this.

This long term study compared women who had done in vitro fertilization (IVF) with two other groups of women; 1)the general population, and 2)sub fertile women who had not done IVF. The researchers reported an increased risk level for the IVF group of developing borderline ovarian tumors. The research also showed that the overall incidence of invasive ovarian cancer was not significantly elevated, but increased with longer follow up.

The important thing to note here is that borderline ovarian tumors are actually cysts of low malignant potential. I am not minimizing the value of this study However, the term as is being reported in Reuters and picked up by media outlets, that women are twice as likely to develop ovarian cancer after IVF, is misleading. Patient’s individual risk of getting ovarian cancer if they do IVF is not 50% higher than it would be were they not undergoing treatment. The increased risk of acquiring invasive ovarian cancer for this group is around 1.76% greater after 15 years. If you however, put together the statistics for borderline ovarian tumors along with the statistics for ovarian malignancies, the rate goes up to 4.23%. That being said, we don’t want women to wind up in either group if they can help it.

I reached out to Dan Potter, M.D. to get his opinion on the study. His comments, verbatim, were:

“This is no different than the study that was published here in the U.S. about 10 years ago. The lead author is an epidemiologist. Oftimes in studies such as this, the researcher starts with the conclusion they wish to arrive at and then they work backward to prove it. I’m not saying that’s what happened here, but these are the most problematic issues that I see in this study.

1. They linked all of the ‘malignancies’ in the registry to patients in the two study groups (IVF and non-IVF) regardless of whether they returned the surveys or not. This creates a falsely high incidence. They compared them to ‘general population rates’ who basically have the equivalent of a survey return rate of 100%. See how they appeared to start at the conclusion and work backwards?
2. Borderline tumors, also known as tumors of ‘low malignant potential’ or LMP are not malignancies. There is no such thing as ‘invasive cancer’ and ‘non-invasive cancer’. Cancer is invasive. Borderline tumors are not cancer and while not benign have low malignant potential. The 5 year survival rate of borderline serous tumors (the most common type) is ….…100%.
3. They seem to speak of ‘invasive cancer’ and consider the borderline tumors ‘non-invasive’ cancer. The definition of malignancy is invasion so this simply does not make sense from a medical perspective.
4. Their control group is women diagnosed with infertility that did not do IVF. They did not stratify these patients as to whether they became pregnant or whether they were on the birth control pill, both known protective factors. In fact, there is not control for whether the patient even had a hysterectomy or oophorectomy for endometriosis. It is hard to get ovarian cancer when you do not have ovaries. Prior use of fertility drugs in the controls may have led to pregnancy so that they did not pursue IVF. Pregnancy, BCPs, oophorectomy are all protective.
5. There were 19,146 patients in the IVF group and 28 ‘invasive cancers’. Using their methodology they would have expected 21. Both of these number are very high compared to what we would expect in the US (about 10x higher). Not sure why they diagnose it more frequently there.”

So, to sum it up. You should absolutely discuss this study with your physician and weigh your own personal risk, based on medical and family history and genetic background. And, if you want to talk about it, please feel free to call.

Comments:
Great news about fertility treatment from the Netherlands!
The study, a large cohort of Dutch women with infertility, showed that
the incidence of invasive ovarian cancer was NOT increased in either IVF
treated women or Non-IVF subfertile women followed for up to 15 years
after treatment.

The study of 19,146 women who underwent IVF and 6,006 women treated with
lesser forms of fertility therapy over a period of 13 years, found 28
and 9 women respectively developed invasive ovarian cancer, (37 cases /
25,152 women) a rate that was the same as the general population in the
Netherlands.

9 of the 28 cases of invasive ovarian cancer found in IVF treated women
occurred beyond the initial 15 year observation period when the authors
would have expected to find approximately 3. No medical information
about other exposures that these women may have had during those
intervening years was accessible.

Borderline ovarian tumors, a non-lethal ovarian growth that may never
become cancer but may require surgery, were seen more frequently in
women who underwent IVF compared to Non-IVF subfertile women.

There are many risk factors for ovarian cancer and non-lethal borderline
ovarian tumors independent of treatment including infertility itself,
use of exogenous hormones; lifestyle factors; and family history of
cancer. The current study obtained this critical information by
questionnaire.

A limitation of the study is that while 71% of the subjects who
underwent IVF returned the 23 page questionnaire, less than half (48%)
of those who received lesser treatment responded.

Factors known to decrease the incidence of invasive ovarian cancer
including pregnancy and the use of oral contraceptives, now commonly
used in conjunction with IVF treatment, were not independently assessed.

Alan Penzias, MD