A possible link between IVF and eye cancer?

An observational study by Dutch authors in this week's issue of THE LANCET suggests that children conceived by in-vitro fertilisation (IVF) could be at an increased risk of retinoblastoma (a malignant tumour of the retina). However the investigators and authors of an accompanying Commentary stress that it is too early to conclude that there is a true association between IVF and retinoblastoma until larger studies can confirm these preliminary findings.

Retinoblastoma is rare, occurring in around one in 17,000 births in the Netherlands and other western countries. Previous research has not identified an increased cancer risk among IVF children; however Dutch investigators led by Annette Moll from VU University Medical Center, Amsterdam, diagnosed retinoblastoma in five children within 15 months of each other. This prompted the investigators to compare the incidence of retinoblastoma among the 1-1.5% of the Dutch population born after IVF with retinoblastoma incidence in the general Dutch population.

The investigators calculate that children conceived by IVF could be between five and seven times more likely than non-IVF children to develop childhood retinoblastoma, assuming that IVF accounts for 1 to 1.5% of all conceptions in the Netherlands. The retinoblastomas were treated successfully in all five children who have since remained free of the disease.

Annette Moll comments: "Whether treatment with ovulation-inducing drugs increases the risk of childhood cancer is an important matter, especially with the rising numbers of women undergoing treatment for subfertility. Future investigators should consider the number of IVF treatments, other fertility drugs given before IVF, and the possibility that serious disorders in children conceived by IVF are diagnosed earlier than those in other children who do not have such close medical surveillance. Our finding requires further research to confirm the association and to explore a possible causal mechanism."

An accompanying Commentary (p 273) by David BenEzra from Hadassah Hebrew University Hospital, Jerusalem, Israel is cautious about the Dutch findings. He states: "Whatever the "true" incidence of retinoblastoma is after IVF, there is little doubt that a heightened awareness and a multidisciplinary approach with a closer follow-up of children conceived with assisted reproductive technologies is needed…An open debate on this issue is necessary to frame it in its proper context and to minimise potential harmful effects of unfounded and potentially misleading information."

A POSSIBLE LINK BETWEEN IVF AND EYE CANCER? (pp 273, 309)

Contact: Dr Annette C Moll, VU University Medical Center, Department of Ophthamology, De Boelelaan 1117, 1081 HV Amsterdam, Netherlands;
T) (Mariet Budding, Department of communications) +31 20 444 3444;
F) +31 20 444 4745;
E) a.moll@vumc.nl

Professor David BenEzra, Paediatric Ophthalmology Unit, Hadassah Hebrew University, Hospital, Jerusalem, Israel;
E) benezra@md2.huji.ac.il

---

---