Cancer morbidity in a cohort of 9175 Finnish women treated for infertility.

BACKGROUND: Results of earlier studies on cancer risk in infertile women are inconsistent for many cancer types. Our goal was to study cancer incidence among a cohort of women treated with IVF, including ICSI and frozen embryo transfer (FET), compared with that of a control population. METHODS: A cohort of women who purchased drugs for IVF (including ICSI and FET treatments, n= 9175) in the period 1996-1998 in Finland (later called IVF women) and their age and residence-matched controls further adjusted for socio-economic position and marital status were linked to the Finnish Cancer Registry 1996-2004. RESULTS: The overall cancer incidence and combined incidence of hormonal-related breast, uterine and invasive ovarian cancers were similar among IVF women and controls. IVF women had statistically significantly less cervical cancer [odds ratio (OR): 0.51, 95% confidence interval (CI): 0.30-0.85], but more skin cancers other than melanoma (OR: 3.11, 95% CI: 1.02-9.6). IVF women had three times more invasive ovarian cancers than controls, but this difference was not statistically significant, possibly due to the small number of cases. IVF women had slightly fewer breast cancers but difference was likewise not statistically significant. All cases of pulmonary cancer were diagnosed among controls (P= 0.03). CONCLUSIONS: General cancer risk or risk of hormonal-related cancers in women was not increased by IVF. The differences in certain cancers suggest a healthy patient effect or may be partly caused by residual socio-economic differences. More large studies and reanalysis of existing studies are needed to evaluate cancer risk among infertile women by subgroups regarding the cause of infertility. When evaluating risk of cancer after drug exposure, dosage and the use of different medicaments should be taken into consideration.

Psychiatric disorders leading to hospitalization before and after infertility treatments.

BACKGROUND: This study aimed at determining the psychiatric morbidity of women undergoing infertility treatments, before and after treatment as compared with control women. METHODS: The number of women hospitalized because of psychiatric disorders was obtained from the Hospital Discharge Register (1969-2006) in a cohort of women who purchased drugs for in vitro fertilization, intra-cytoplasmic sperm injection or frozen embryo transfer treatments (n = 9175) in 1996-1998 in Finland and their controls (n = 9175). The age- and residence-matched controls were further adjusted in the analysis for socio-economic position and marital status. RESULTS: Women with infertility treatments had fewer hospitalizations due to depression, psychotic disorders, personality disorders, anxiety disorders, bipolar disorder or mania, eating disorders, adjustment disorders and alcohol or other intoxicant abuse before their treatments than did controls. However, the difference was statistically significant only for psychotic disorders [Odds ratios (OR) 0.38, 95% confidence intervals (CI) 0.20-0.72]. Differences in hospitalization remained similar also during the 10-year post-treatment follow-up. The exceptions were increased risk of hospitalizations due to adjustment disorders (OR 3.43, 95% CI 1.03-11.4) and decreased risk of alcohol or other intoxicant abuse (OR 0.44, 95% CI 0.25-0.75) among the women with infertility treatments. The infertile women who gave birth had fewer hospitalizations for all psychiatric diagnoses than did infertile women who did not have a baby. The difference was statistically significant for anxiety disorders (OR 0.38, 95% CI 0.18-0.81), depression (OR 0.63, 95% CI 0.41-0.96) and alcohol or other intoxicant abuse (OR 0.38, 95% CI 0.18-0.80). Hospitalizations among infertile women who did not have a baby and controls were similar, with the exception of significantly more hospitalizations for psychotic disorders among controls (OR 0.38, 95% CI 0.19-0.77). CONCLUSIONS: Women treated for infertility had less serious psychiatric morbidity leading to hospitalization than did the controls, both before and after treatments, suggesting a healthy patient effect. After treatments, the risk of hospitalization due to adjustment disorders was increased among the infertile women. Having a baby after infertility treatments was associated with fewer hospitalizations following psychiatric diagnosis.

Success of infertility treatments in Finland in the period 1992-2005.

OBJECTIVES: The objective was to study the success rates of infertility treatments in the period 1992-2005 in public and private clinics. STUDY DESIGN: Aggregate IVF statistics (1992-2005) and nationally representative cross-sectional survey (2002). RESULTS: The success rates of infertility treatments remained stable, despite a substantial increase in single-embryo transfers. In 2005, the clinical pregnancy rate was 23/100 initiated cycles and a live birth rate of 17/100 cycles. The proportions of term singletons and singletons weighing at least 2500g improved over time and both rates were 14/100 in 2005. Pregnancy rates improved most among older women during the study period. The success rate in the private sector was significantly better than that in the public sector among women younger than 35 years. CONCLUSION: The single-embryo policy has not decreased pregnancy and birth rates. The proportions of term singletons per initiated cycle and singletons weighing at least 2500g per initiated cycle have improved over time. The higher success rate in the private sector may be because of different clientele.