title: Ovarian epithelial dysplasia in relation to ovulation induction and nulliparity.
abstract: OBJECTIVE
  The goal of this study was to assess the relationship between ovulation induction, nulliparity, and ovarian epithelial dysplasia.
  
  
  METHODS
  This retrospective cohort study was performed in one teaching and one district general hospital in London. The subjects, 83 women who had undergone hysterectomy and bilateral oophorectomy and whose ovaries were reported as "normal," were divided into three groups: ovulation induction (13), nulliparity (20), and fertile controls (50). These ovaries were independently reviewed by two pathologists who assigned a score of 0, 1, or 2 to nine epithelial cytological and architectural features. The main outcome measure was the total dysplasia score, which was used to quantify the degree of ovarian epithelial abnormality in the three groups.
  
  
  RESULTS
  The mean dysplasia score was significantly higher in the women who had undergone ovulation induction than in the fertile controls (7.92 vs 5.70, P = 0.012). The magnitude of the difference between the ovulation induction group and controls remained similar after adjusting for age, parity, and duration of oral contraceptive use (2.17, 95% CI: -0.11-4.44). However, the statistical significance of this difference was reduced (P = 0.062). We did not find any evidence of a difference in dysplasia score between nulliparous women and controls, neither before (P = 0.85) nor after adjusting for age and duration of oral contraceptive use (P = 0.87).
  
  
  CONCLUSIONS
  These results suggest a possible association between ovarian epithelial dysplasia and ovulation induction therapy, in accord with previous reports of increased risk of ovarian cancer in women with a history of fertility treatment. The higher dysplasia score could be attributable to the drugs used to induce ovulation or to a genetic susceptibility to ovarian cancer.
authors.affiliation: University Department of Obstetrics and Gynaecology, University College Medical School, London, United Kingdom.
authors.forename: J J
authors.initials: JJ
authors.lastname: Nieto
authors.forename: J
authors.initials: J
authors.lastname: Crow
authors.forename: M
authors.initials: M
authors.lastname: Sundaresan
authors.forename: N
authors.initials: N
authors.lastname: Constantinovici
authors.forename: C W
authors.initials: CW
authors.lastname: Perrett
authors.forename: A B
authors.initials: AB
authors.lastname: MacLean
authors.forename: P J
authors.initials: PJ
authors.lastname: Hardiman
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004847:Epithelial Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000473:pathology; D010052:Ovariectomy; D010053:Ovary / Q000473:pathology* / Q000601:surgery; D010062:Ovulation Induction; D010298:Parity; D011230:Precancerous Conditions / Q000473:pathology; D012189:Retrospective Studies