Egg Retrieval and Cancer Risk in Women
Based on the highest quality guideline evidence, egg retrieval for fertility preservation does not increase women's risk of cancer, even in those with hormone-sensitive tumors.
Evidence from Major Guidelines
The American Society of Clinical Oncology (ASCO) has consistently stated across multiple guideline updates that there is no increased risk of cancer recurrence from fertility preservation methods or pregnancy, even in hormonally sensitive tumors 1, 2. This represents the consensus position from the leading oncology society based on available data through 2013 and reaffirmed in subsequent analyses 2.
Key Safety Points
No detectable increased cancer risk: Data are limited but reassuring, showing no increased risk of cancer recurrence from fertility preservation methods including egg retrieval 1.
Safe even in hormone-sensitive cancers: Women with hormone receptor-positive breast cancer can safely undergo egg retrieval without increased recurrence risk 1, 2.
Aromatase inhibitor protocols available: For women with estrogen-sensitive cancers, letrozole-based stimulation protocols can be used during egg retrieval to keep estrogen levels near physiologic ranges while still achieving adequate egg collection 1, 2.
Understanding the Research Context
Transient vs. Long-term Risk
One older study from 1999 showed a transient increase in breast and uterine cancer diagnoses within 12 months of fertility treatment, but overall incidence was no greater than expected in the general population 3. This likely represents detection bias—cancers that were already present being discovered during the workup and monitoring associated with fertility treatment 3.
Conflicting Data on IVF
A 2016 cohort study suggested increased risk of ovarian and uterine cancer after IVF 4. However, this conflicts with:
- Multiple ASCO guideline statements showing no increased risk 1, 2
- A comprehensive 2018 review concluding fertility treatments do not increase risk of breast, cervical, endometrial, or ovarian cancers 5
- The European Society for Medical Oncology (ESMO) 2020 guidelines stating no increased cancer risk from assisted reproductive technology 6, 2
The guideline consensus clearly outweighs this single conflicting study 1, 2.
Infertility Itself as a Risk Factor
A critical distinction: Underlying infertility—particularly unexplained infertility—is itself associated with increased ovarian and uterine cancer risk 3. This confounding factor makes it difficult to separate cancer risk from the fertility treatment versus the infertility condition itself 5.
Clinical Implications
Counseling Patients
When discussing egg retrieval with patients:
Reassure about cancer risk: The procedure itself does not meaningfully increase cancer risk based on guideline-level evidence 1, 2.
Emphasize timing: Egg retrieval should be performed before cancer treatment begins when possible, as this is the optimal window for fertility preservation 1.
Address hormone concerns: For women with hormone-sensitive cancers, aromatase inhibitor-supplemented protocols are available and do not increase recurrence risk 1, 2.
Common Pitfalls to Avoid
Don't delay cancer treatment unnecessarily: Egg retrieval can often be completed within 2-4 weeks, and random-start protocols allow stimulation at any point in the menstrual cycle 1.
Don't withhold fertility preservation due to unfounded cancer fears: The quality-of-life benefits of preserving fertility typically outweigh any theoretical risks 2.
Don't confuse correlation with causation: Some studies showing increased cancer rates in fertility treatment patients likely reflect the underlying infertility condition rather than the treatment itself 5, 3.
Special Populations
BRCA Mutation Carriers
Women with BRCA1/2 mutations may have diminished ovarian reserve and could be more prone to chemotherapy-induced infertility 1. However, egg retrieval itself does not increase their already-elevated cancer risk 6, 2. These patients should be counseled about preimplantation genetic diagnosis options 1, 6.
Post-Cancer Survivors
For women who have completed cancer treatment, pregnancy should not be discouraged for safety reasons, even in those with prior hormone receptor-positive breast cancer 1, 2. If egg retrieval is needed during oncologic follow-up, evidence remains reassuring though more limited 1.