Episode 79: Does IVF Cause Cancer? A conversation with Professor Alastair Sutcliffe
In this episode, Dr Bahijja Raimi-Abraham discusses health effects of assisted reproductive technologies such as In-vitro fertilisation (IVF) with Professor Alastair Sutcliffe, an internationally known expert on IVF and developmental and adolescent paediatrician at University College London Hospital.
Dr Bahijja: To start, could you tell us a bit about yourself?
Dr Sutcliffe: I am a children doctor and academic at the UCL Institute of Children’s Health, and have dedicated over 30 years of my life to the treatment of sick children. I have since also conducted many research projects, initially into assisted conception technologies, and now subsequently into new and related areas.
Dr Bahijja: What is your favourite song at the moment? And do you have any book recommendations?
Dr Sutcliffe: My favourite song is Tuyo, by Rodrigo Amarante. It also happens to be the theme song for Narcos. The best book I’ve read in my entire life is called “Thinking Fast, Thinking Slow” — the author actually won a Nobel Prize for it. I actually wrote him at one point letting him know I enjoyed his book, and he wrote back. It is definitely a tough read but I learnt a lot about human thought processes and their flaws.
Dr Bahijja: I noticed you have multiple doctorates, could you talk a bit about that?
Dr Sutcliffe: I initially did my MD, during which I completed collection of studies in regard to IVF children. However, I was conscious that at the time PhDs were more respected, so I contacted my alma mater (Manchester University) to see if I could complete a PhD via published papers. I then explored whether I would be able to do that at UCL — however, it turns out UCL is one of the few places that doesn’t allow people to obtain PhD’s via published papers. I then ended up getting my PhD at the Free Univesity of Brussel’s.
Dr Bahijja: Could you tell us a bit about your research into assisted reproductive therapies?
Dr Sutcliffe: First, I’ll give a little background into IVF. IVF was invented in the United Kingdom, and the inventor was actually awarded the Nobel Prize for his discovery. Quickly, it was regarded as one of the most important discoveries of our lifetimes in the last 200 years. At the time it was experimental, and because of that, the oldest child conceived via IVF alive today is around 40 years old. Since there, there have been massive advances.
As IVF and ART have gotten more effective, but also more broadly applied, we have been looking more at the health of children (and now adults) that are conceived via IVF. I have made various discoveries through my own research — for example, I was the first to recognise that Beckwith-Wiedemann syndrome was more common in children conceived via IVF.
What is Beckwith-Wiedemann syndrome or BWS? BWS is a a disorder affecting growth in the body that is associated with overgrowth (such as abnormally large organs, including the skin, tongue, and overall large body size) and a significant increase in risk for developing cancer.
Generally speaking, my work has shown that most infants conceived via IVF and ART are healthy, but there are definitely some concerns to be aware of. I am also now looking into how fertility can provide insight into overall somatic (bodily) health, especially in sub-fertile men. I am scientifically neutral, however, meaning I do not actually practice IVF as a doctor, which might be relevant to my research.
Dr Bahijja: Could you elaborate more on the concept of being scientifically neutral?
Dr Sutcliffe: I am definitely not saying I am an unbiased researcher, as I am a human and its in our nature — however, a lot of children’s research has come from people who have a hang out in advance. For example, there is an abundance of research into congenital anomalies, but very little into conditions that are more difficult to study. Similarly, I also do not have any personal stake into IVF or ART, as I don’t practice them as a physician. So if I were to discover an “inconvenient truth”, [there is essentially a lesser chance of conflict of interest]. [These hangups and conflicts of interest manifest in many ways, such as poor research study design or making conclusions based off correlation].
Dr Bahijja: Could you talk more about your study addressing cancer risks associated with ART and IVF?
Dr Sutcliffe: There two different components related to this — one study regarding sub-fertile women, and then there is the research concerning the actual children. For the children, I was very fortunate to speak at a small congress where Sir David Barker was present — a concept I got from that was resilience. A measure of resilience of health of a population is cancer, which is why cancer rates are generally very well recorded globally.
Generally, we might say that a less healthy population has a higher rate or risk of cancer. As I was already interested in ART, I then completed a big study without any initial presumption that there would in fact be a higher cancer risk. It was essentially a measure of resilience for that population. We completed one report for donors and one for non-donor sperm conceived children. We found that there wasn’t necessarily a higher risk.
For the women involved in IVF, there has been evidence suggesting a higher risk of cancer. I personally looked at risks, and it seems like much of the risk is due to the inherent risk of their existing group (such as having had few v.s. many children).
Dr Bahijja: Has there been any evidence of congenital abnormalities in children conceived via IVF or ART?
Dr Sutcliffe: We actually have yet to complete that work, we are currently looking into the general health of children conceieved via IVF — including perinatal health, physiological (including birth defects) and then also psychological health. The analyses are being completed at the moment (analysing data from the registry from 1991 to 2010) by the time, so the results will be available soon.
Dr Bahijja: Based on this study, what are your thoughts on people with increased cancer risk then using IVF or ART? Is there a contraindication?
Dr Sutcliffe: There isn’t any contraindication, these risks are still very small in terms of absolute risk. In individual situations, however, especially with cancers related to oestrogen (such as certain breast cancers), an individual would need to consult with their doctor or a similar expert in the field to assess the risk.
Dr Bahijja: Do you think the increased rates of egg freezing will change the health issues we see in the population?
Dr Sutcliffe: I don’t think it will affect the women themselves, however, from some clinics I have heard that many of the women who have their eggs frozen do not actually return for them in the future. [This obviously is a specific clinic, and may not be representative, however].
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