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.