I am 32 and have been going through the infertility mill. I've had Clomid, two surgeries to remove my tubes, four IUIs with injectables (resulting in one conception that didn't take and a subsequent D&C), and a round of IVF (with another conception that didn't take). I'm now on my the second IVF try, with all of the prescriptions that go with that. I'm so worried about what all of this is doing to my body. I know that there are always some risks involved, but are there any new studies that are concrete?

J.D.

Recent studies show that there is no long-term health risk to fertility treatments. Early studies suggested that long ovulation induction treatment may increase the risk of ovarian cancer, but this has not been borne out in more recent, well-designed epidemiologic studies.

We know that infertility is associated with an increased risk of ovarian cancer. Is that due to treatment? We don't think so. It appears that infertility itself may be the culprit. First of all, when compared to women who have had children, those who have breastfed, or those who have used birth control pills, women who have had infertility have a higher risk of ovarian cancer. This is because birth control pills, pregnancy and breastfeeding provide protection against this cancer.

Early studies noted that some of the cancers were noted within months of fertility treatment, and these cases were listed in the potential treatment- caused cancers. Yet it would have been impossible for the treatment to have caused these cancers. Based on rates of cell division, the cancer could not have developed and grown to a detectable size in the period of time noted.

Instead, investigators have been led to ask whether ovarian tumors, before they are detected, secrete chemical messengers or hormones that interfere with fertility. In other words, does ovarian cancer cause infertility? The likely answer to this is yes.

Based on the current evidence, I suggest that patients take judicious steps to achieve a pregnancy, breastfeed their infants after delivery, and choose a birth control pill if contraception is desired at future point. I do not believe that there is sufficient evidence to suggest that avoiding fertility treatment will lead to a decreased risk of cancer.