In its 2024 guideline, the American Society for Reproductive Medicine (ASRM) says there does not appear to be an increased risk of breast cancer associated with assisted reproductive technology (ART). That is reassuring, but it is not proof that risk is zero for every person or treatment history. ASRM also advises avoiding prolonged clomiphene use beyond 10 cycles. Do not stop or change fertility medication without speaking with the prescribing clinician.
What does the evidence say about IVF and breast cancer?
ASRM’s 2024 guideline concludes that an increased breast cancer risk has not been demonstrated overall for ART treatments. ART includes treatments such as in vitro fertilization (IVF). The recommendation is about the evidence across groups; it cannot determine an individual patient’s risk or establish that every regimen has no risk.
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ASRM’s literature search identified 1,077 articles and included 52 studies in the guideline update. The search covered publications through November 30, 2022, so the recommendation reflects evidence available up to that date. ASRM’s 2024 guideline states: “Women should be informed that there does not appear to be an increased risk of breast cancer associated with ART treatments. Prolonged (>10 cycles) of clomiphene should be avoided.”
How should the findings be interpreted?
Studies have not all reached the same result. ASRM reports that most studies and all systematic reviews and meta-analyses it considered found no significant increase or a decrease in risk. One intermediate-quality study found an increased risk. A meta-analysis of 20 studies, as summarized by ASRM, found that hormonal treatments for infertility were not associated overall with increased breast cancer risk. These findings are reassuring at the population level, but they do not prove that risk is absent for every patient.
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Some studies compare people who received treatment with the general population; others compare them with people who had infertility but did not receive fertility medication. Those are different comparison groups. A large cohort summarized in the guideline found no statistically significant increase for IVF compared with untreated women with infertility (hazard ratio 1.10; 95% confidence interval 0.88–1.36). The estimate is a relative measure for that study, not an estimate of any one person’s absolute risk.
In a cohort with more than 30 years of follow-up, ever-use of clomiphene was not associated with breast cancer (hazard ratio 1.05; 95% confidence interval 0.90–1.22), nor was gonadotropin use (hazard ratio 1.14; 95% confidence interval 0.89–1.44). These cohort results are summarized by ASRM; they are not studies conducted by the society. A confidence interval crossing 1 means the study did not show a statistically significant increase, but it does not establish that the true effect is exactly zero.
Why is it difficult to separate treatment effects from infertility?
People seeking fertility care may differ from the general population in ways that affect cancer risk. ASRM identifies infertility-related factors, including endometriosis, and notes that women who never conceive have an increased cancer risk. If studies do not account adequately for these differences, an observed association may reflect underlying factors rather than treatment—or may obscure a treatment effect.
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Other limitations include inadequate control groups, recall bias, and failure to control for cancer risk factors associated with infertility. Breast cancer can be diagnosed years after fertility treatment, while many cancers are uncommon; that makes long follow-up and sufficiently large studies important, and causal conclusions difficult.
What does the clomiphene guidance mean?
ASRM specifically advises avoiding prolonged clomiphene use beyond 10 cycles. This is a guideline recommendation, not a direction to alter a prescribed plan on your own. If you have taken clomiphene for multiple cycles or are considering further treatment, ask your fertility clinician how the recommendation applies to your treatment history and alternatives.
Independent reader supportYour contribution helps us test, update, and keep practical guides available for everyone.What should you ask your clinician?
- Which treatment and medication regimen is proposed, and how many cycles are planned?
- How do my infertility diagnosis, family history, and other personal risk factors affect the discussion?
- Should my fertility clinician coordinate with a breast-care clinician based on my history?
- What follow-up or screening is appropriate for me?
Do not stop, delay, or change prescribed treatment because of a general risk summary. The appropriate advice depends on your medical history and treatment plan.
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