Infertility is so sharply on the increase in the West that it nowaffects one in six couples at some point in their reproductive lives. These days, the childless are led to believe that modern chemistry can easily do something about it, and increasing number of couples are seeking infertility treatment or some form of "assisted conception".

The number of visits to US doctors for infertility services rose from 600,000 in 1968 to about 1.6 million in 1984 and the number of prescriptions for clomiphene dispensed by US pharmacies nearly doubled from 1973 to 1991. In 1988, approximately two million women said that they had taken fertility drugs. (N Engl J Med, Sept 22, 1994).

But there is strong evidence to suggest that many of them particularly women are being exposed to drugs may be doing absolutely no good and a great deal of harm.

Ovarian cancer and breast cancer are the latest risks to be associated with fertility drugs. These are in addition to a further catalogue of side effects and adverse outcomes already documented in WDDTY (vol 1 no 8), including Ovarian Hyperstimulation Syndrome (OHSS) a serious condition in which there is a build-up of fluid in the abdomen, thorax and sometimes the sac surrounding the heart; and thrombosis in the veins or arteries, which could lead to a heart attack, stroke or loss of a limb. Other risks associated with the drugs include ectopic and multiple pregnancy and multiple births. The latter two are common occurrences which carry further risks such as miscarriage, stillbirth, fetal abnormalities, premature and low birthweight babies.

These babies are much more susceptible to developmental problems, illness and death.

According to the Office of Population and Census Surveys, the rate of multiple births in England and Wales has increased since 1980, when it was 0.98 per cent, compared with 1.25 per cent in 1992. The Human Fertilization and Embryology Authority believe this is due to the use of superovulatory drugs in fertility treatment.

In about half of all infertility cases, there is a contributing male factor. Yet fertility drugs to induce ovulation are often given to women when the cause of infertility is not known, and regardless of whether or not they have ovulation problems.

Ovulation is induced to increase the chances of success in assisted conception therapy, which includes in vitro fertilization (IVF), when an egg is surgically removed from an ovary, fertilized outside the body and then placed in the uterus; gamete intra-fallopian transfer (GIFT), when the eggs are placed with sperm in the fallopian tubes; and zygote intra-fallopian transfer (ZIFT), when the eggs are removed from the ovaries, fertilized outside and placed in the tubes.

In the US, at least 12.5 million courses of fertility drugs have been prescribed since they were launched in the 1960s. In January 1993, the US Food and Drug Administration asked drug manufacturers to add the risk of ovarian cancer to the possible adverse reactions listed on fertility drug labels such as clomiphene citrate (Clomid) and menotrophins. The decision was prompted by an evaluation of the results of 12 studies (analyzed by The American Collaborative Ovarian Cancer Group based at Stanford University, California, and published in the American Journal of Epidemiology) on risk factors for ovarian cancer. These found that the risk of invasive ovarian cancer amongst infertile women who had taken fertility drugs was almost three times that of fertile women, and that infertile women who had not taken fertility drugs were not at increased risk (The Lancet, Jan 23, 1993).