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Fertility Preservation Through Oocyte Vitrification: Clinical and Laboratory Perspectives
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Medically Assisted Reproduction and Hormone-Related Cancers.

Adrian Raymond Walker1, Christos Venetis1,2, Signe Opdahl1,3

  • 1Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia.

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Medically assisted reproduction (MAR) treatments show small associations with hormone-related cancers, but these risks may be explained by confounding factors and detection bias, not the treatments themselves.

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Area of Science:

  • Reproductive Medicine
  • Oncology
  • Epidemiology

Background:

  • Medically assisted reproduction (MAR) treatments are widely used globally.
  • Understanding the potential long-term health risks, particularly cancer, associated with MAR is crucial for informed patient and clinician decision-making.
  • Previous studies have yielded conflicting results regarding MAR and cancer risk.

Purpose of the Study:

  • To investigate the association between medically assisted reproduction (MAR) treatments and the risk of developing hormone-related cancers.
  • To differentiate between true treatment effects and risks attributable to underlying infertility conditions or detection bias.

Main Methods:

  • A large cohort study utilizing Australian health registries and administrative data with an emulated target trial design.
  • Inclusion of women aged 18-55 undergoing MAR treatments (assisted reproduction therapy, intrauterine insemination, ovarian stimulation, ovulation induction) between 1991-2018.
  • Analysis of hormone-related cancers (breast, ovarian, uterine, thyroid, colorectal, melanoma) and negative control cancers (pancreatic, lung, hematological) using flexible parametric survival models and E-values to assess confounding.

Main Results:

  • While associations between MAR and some hormone-related cancers were observed (HRs 1.09-1.64), E-value analyses suggested confounding by infertility conditions for uterine, ovarian, and thyroid cancers.
  • The estimated excess cancer cases were minimal (<20 per 100,000 women annually).
  • Increased risk of hematological cancers (HRs 1.18-1.27) may be due to unmeasured confounding (e.g., race/ethnicity), and early increases in risk for several cancers suggest detection bias.

Conclusions:

  • Observed associations between MAR treatments and hormone-related cancers are likely small and potentially explained by unmeasured confounding factors and detection bias.
  • The study provides reassurance regarding the cancer risk associated with MAR treatments.
  • Further research is needed to fully elucidate the complex interplay between infertility, MAR treatments, and cancer risk.