The use of ARTs and ovulation promotion has raised concern about potential risks to the women who undergo these procedures and the children who are conceived as a result. Some investigators have speculated about the effects of fertility drugs on the risk of breast cancer and cancers of the reproductive system. A study by Klip and colleagues (2000), in which a cohort of women in The Netherlands was monitored for 5 to 8 years, found no increase in the risk of breast cancer or ovarian cancer in women who underwent IVF compared with that in subfertile women who had not undergone IVF. The study also found that both women who had undergone IVF and subfertile women did not have an increased risk for endometrial cancer. The authors suggest a potential link between endometrial cancer and subfertility.
Other risks associated with hormonal ovulation stimulation include ovarian hyperstimulation syndrome, in which fluid imbalances and ovary enlargement become problematic; rupture of the ovaries is also a possibility (for a review of the well-being of women during the use of ARTs, see The Presidents Council on Bioethics ). Multiple pregnancies pose higher risks of mortality and morbidity to the mothers than singleton pregnancies. Mothers with multiple pregnancies are more likely to experience high blood pressure, anemia, preeclampsia, and gestational diabetes and to require delivery by cesarean (Sebire et al., 2001; Wen et al., 2004).
Of central interest in the discussion of the unintended consequences of the use of ARTs is the well-being of the children conceived through the use of these procedures. Although large-scale and long-term follow-up studies of these children are lacking, recent evidence associates some ART procedures with certain birth defects as a result of defects in DNA methylation, such as Beckwith-Wiedemann syndrome, retinoblastoma, and Angelman syndrome (Jacob and Moley, 2005; Neimitz and Feinberg, 2004). However, the prevalence of these conditions is extremely low. Concern has been raised about the use of intracytoplasmic sperm injection, as this procedure impedes the ovum's natural ability to resist fertilization by a sperm that would otherwise not have the ability to fertilize the egg. However, these risks are considered small, and the greater risk from the use of these procedures results from the consequences of multiple gestations.
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