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Liz
Tilberis, the vibrant, dynamic editor of the fashion
magazine Harper's Bazaar, faced ovarian cancer with
the same determination she brought to every other part
of her life. While pursuing every possible treatment,
she also raised public consciousness and millions of
dollars for ovarian cancer research and awareness. But
there was surprisingly little public attention devoted
to what Tilberis' doctors had told her was the most
likely cause of her illness: the fertility drugs she
had taken years before.
I
talked with Tilberis in 1994, only months after she
had been diagnosed with late-stage ovarian cancer. She
told me that in the 1980s, while still living in England,
she had undergone nine unsuccessful attempts at in vitro
fertilization (IVF). (In this procedure a woman is given
powerful drugs to stimulate her ovaries to produce multiple
eggs. The eggs are then collected and fertilized with
her partner's sperm, and the resulting embryos are transferred
to her uterus.) Tilberis and her husband, Andrew, later
adopted two boys.
At
the time we spoke, Tilberis believed she had beaten
her cancer. When I asked her if she was angry about
the fertility drugs, she didn't hesitate. "No," she
said, and then added, "But I am now well. If I was dying
and had a month to go, I would probably be very, very
angry about the fertility treatments." Last year Liz
Tilberis died after a five-year battle with ovarian
cancer.
At
the time of the interview, the issue of fertility drugs
and cancer was just starting to hit the media. An analysis
of several studies by Alice Whittemore of Stanford University
School of Medicine had found that the risk of ovarian
cancer among women who received fertility treatments
was almost three times that of women who had not taken
fertility drugs. Those who had taken fertility drugs
and did not go on to have a child were at even greater
risk. (In subsequent studies, assessments of the risks
have varied widely.)
What's
disturbing is that many of these powerful hormonal stimulants
used to boost egg production have been given to women
for over 20 years, but their relation to cancer has
never been seriously studied. Yet the link between hormones
and reproductive cancers has been an accepted theory
for years. (Although there still has not been any conclusive
cancer research, a major government-sponsored study
is underway. And the FDA now requires many fertility
drugs, such as Pergonal, Clomid, and Gonal-F, to carry
a warning that they may increase the risk of ovarian
cancer.)
Concerns
about a link between ovarian cancer and fertility drugs
have been raised discreetly among medical practitioners,
but rarely discussed with patients. In 1989, I interviewed
Dr. Jacques Testart, a leading French biologist who
developed many of the techniques used in assisted reproduction.
I had been told that Testart was concerned that the
high doses of fertility drugs used in assisted reproduction
might cause reproductive cancers. When I raised the
subject, his candor almost took my breath away. He said
he believed that in ten years there would be an epidemic
of premature menopause and reproductive cancers caused
by the drugs. And then I asked why he and other scientists
were continuing their work despite these concerns. Testart's
answer was chilling. "Because," he told me, "we are
learning a lot about conception and contraception, and
that is the important thing."
The
Big Hype
The
risk of ovarian cancer is just one of many problems
that have been overshadowed by the hype surrounding
the assisted reproductive revolution since the birth
of the world's first test-tube baby in 1978. Assisted
reproductive technologies (ARTs), which involve surgically
removing eggs from a woman's ovaries, and using a variety
of techniques to achieve pregnancy, are built on two
conflicting realities. The overwhelming public impression
is that these technologies are miracles of science that
benefit both women and society. ARTs have been promoted
by the media and the medical profession as a means of
expanding reproductive options for women and, more recently,
as the door to an array of genetic manipulations with
the potential to eliminate scores of diseases. Largely
hidden in the background has been another, darker reality.
From the beginning, this has been a science driven as
much by profit as by "medical necessity." As a result,
infertile women may be playing with fire when they decide
to use ARTs.
In
the United States, ARTs have provoked Senate hearings,
consumer legislation, lawsuits over everything from
false advertising to risky medical procedures to the
misuse of embryos, and investigations into the practices
of dozens of clinics and doctors. Because of a governmental
moratorium on federal funding for research using human
embryos, virtually all of the ART treatments developed
in the U.S. have been funded privately, and there is
little supervision--or accountability, except to the
company providing the money.
For
the past 12 years, I have researched and written on
assisted reproduction. As the techniques have proliferated,
it has become clear that assisted reproduction is less
about empowering women and increasing their choices
and more about serving the interests of scientists,
doctors, and the pharmaceutical industry. If curing
infertility were truly the goal, then the focus would
not be on a high-tech medicine but on, for example,
eliminating sexually transmitted diseases--one of the
leading causes of infertility--or improving the health
of low-income women, who are particularly vulnerable
to problems with infertility. But, of course, in the
U.S., low-income women are not the market for assisted
reproduction. While the majority of assisted reproductive
techniques are centered on women, ARTs are not women-centered.
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