Dear Professor Winston
I am 36 years old and have been diagnosed with high FSH (circa 17) and low AMH (circa 3.4). I have had two rounds of IVF which have resulted in pregnancy, though sadly the first ended in miscarriage at 16 weeks. However the second resulted in my son, now 14 months. I am currently considering my options in respect of further IVF treatment. My family history means that I am at high risk for breast cancer and it seems to me that research into IVF medication and breast cancer seems to be quite topical at the moment. On this basis I am wondering whether to try a natural IVF cycle in order to avoid the drugs. However when I mentioned this to my consultant he was very dismissive of the idea hinting that it was a bit of a marketing ploy and of no real value. I’ve not responded too badly to the drags in the past (6 eggs collected first time round, 4 the second) and my consultant has said the treatment obviously works for me so I should try it again. I would be interested to hear your views on natural IVF in light of my diagnosis. Secondly the use of DHEA for those with diminished ovarian reserve also seems to be quite topical at the moment. When I had my first IVF treatment in 2011 my consultant was very anti DHEA, but I now note that there are clinical trials running in the UK to test its efficacy in IVF, and I also see that some UK based clinics are now recommending its use by women with my diagnosis. Again I’d be interested to hear your thoughts on this. Finally, thank you for giving up your time to answer queries such as this one. Its a wonderful thing you do. Many thanks A
It does sound as if you have been a bit lucky to have a child, and very unlucky to lose a pregnancy as late as 16 weeks – which is really unusual; were you given any explanation for this?
There is no serious evidence that the fertility drugs used in IVF – a very brief exposure at best to high levels of oestrogen – is likely to to increase your risk of breast cancer. For the last twenty years this has been a source of concern but no serious research in many large populations can confirm this increases the average woman’s risk to breast cancer. Nor, in all probability, does it increase the risk of somebody with a family history – though of course, you may be a carrier of one of those genetic mutations which make breast cancer more likely. Have you had your DNA tested, because this can now be done for people with a strong family history? So low dose, or natural IVF, or even standard IVF treatment should not make any difference. Actually, it could be that having another pregnancy is the greater risk.
With regard to DHEA, I am not very impressed by the published work on the subject. I have not seen a convincing trial which makes me feel this is worth serious consideration except as a research project – and if you have it, make certain that you realise you should not be paying for a research treatment. It is up to the sponsors of the research to raise the funds and any other practice is in my view unethical.
Lastly, it is of course possible now to screen embryos for some of the mutations which predispose to cancer, particularly breast cancer. So if you have, for example, the BRACA1 mutation preimplantation genetic diagnosis can be considered. This is not a research procedure and it isn’t cheap, but it is an option that may be considered justified in people like yourself, assuming the mutation is present.