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#Grand Rounds

Are Men Who Become Fathers Through IVF More Likely to Be Diagnosed with Prostate Cancer?

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BACKGROUND AND PURPOSE:

  • Previous evidence suggests a possible link between infertility and prostate cancer risk
  • Al-Jebari et al. (BMJ, 2019) compared severity of prostate cancer between men undergoing ART vs those conceiving naturally

METHODS:

  • National register-based cohort study
  • Participants
    • Fathers to children born alive in Sweden
    • Grouped by mode of conception
  • Groups
    • IVF
    • ICSI
    • Natural conception
  • Primary outcomes
    • Prostate cancer diagnosis
    • Age of onset
    • Androgen deprivation therapy (serving as proxy for advanced or metastatic malignancy)

RESULTS:

  • Total of 1,181,490 fathers
    • IVF: 20,618
    • ICSI: 14,882
    • Natural conception: 1,145,990

Prostate Cancer and Age of Onset

  • IVF group
    • Prostate cancer diagnosis: 0.37%
    • Mean age at onset: 55.9 years
  • ICSI
    • Prostate cancer diagnosis: 0.42%
    • Mean age at onset: 55.1 years
  • Non-assisted means
    • Prostate cancer diagnosis: 0.28%
    • Mean age at onset: 57.1 years
  • ART conception was significantly associated with increased risk of prostate cancer vs natural conception
    • ICSI: Hazard ratio (HR) 1.64 (95% CI, 1.25 to 2.15)
    • IVF: HR 1.33 (95% CI, 1.06 to 1.66)
  • ART conception was also associated with increased risk of early onset disease (>55 years)
    • ICSI: HR 1.86 (95% CI, 1.25 to 2.77)
    • IVF: HR 1.51 (95% CI, 1.09 to 2.08)
  • Men who conceived through ICSI and developed prostate cancer received androgen deprivation therapy (proxy for metastatic disease) at rates similar to natural conception (P=0.07)

CONCLUSION:

  • Fathers who used ICSI to conceive had a 60% higher risk for prostate cancer (especially early onset) vs natural conception | IVF associated with a 30% higher risk compared with men who conceived naturally
  • The authors suggest that men with infertility who achieve fatherhood through ART are a risk group for prostate cancer and screening may be beneficial
  • Authors acknowledge study limitations including
    • Study did not include infertile men who could not father children | Mean age at follow up only 45 years so study could not assess lifetime risks
  • An accompanying editorial suggests male infertility possibly related to abnormalities in the Y chromosome could explain the increased cancer risk
    • However, the authors of the editorial go on to state that

In the absence of a plausible mechanism of action or proof of causation, justifying screening for prostate cancer in all infertile men is difficult

Learn More – Primary Sources:

Risk of prostate cancer for men fathering through assisted reproduction: nationwide population based register study

Editorial: Assessing Whether Infertile Men Have a Higher Risk of Prostate Cancer

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Related ObG Topics:

Are Children Born After use of ART and Fertility Drugs at a Higher Risk of Childhood Cancer?
Does Assisted Reproduction Increase Risk of Breast, Ovarian, Uterine Cancer?
Children Conceived by ART and Cancer Risk: Results from the OMEGA Offspring Cohort

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