Ovarian epithelial neoplasia after hormonal infertility treatment: long-term follow-up of a historical cohort in Sweden.
OBJECTIVE
To study the association between hormonal infertility treatment and ovarian neoplasia.


METHODS
Historical cohort study.


METHODS
Three university hospitals in Sweden.


METHODS
A total of 2,768 women assessed and treated for infertility and infertility-associated disorders between 1961 and 1975.


METHODS
Exposed women received clomiphene citrate and/or gonadotropins.


METHODS
Incidence of ovarian neoplasia.


RESULTS
No overall excess risk of invasive ovarian cancer emerged compared with the general population. In women with gonadotropin treatment for non-ovulatory disorders, the risk was elevated (standardized incidence ratio [SIR] = 5.89; 95% confidence interval [CI] 1.91-13.75); four of the five cases reported hCG treatment only, rendering the biological plausibility uncertain. Multivariate analysis within the cohort indicated that treatment with gonadotropins only was associated with an increased risk of invasive cancer (relative risk = 5.28; 95% CI 1.70-16.47). For borderline tumors, a more than threefold overall increase of tumors (SIR = 3.61; 95% CI 1.45-7.44) was noted; women exposed to clomiphene because of ovulatory disorders showed the highest risk (SIR = 7.47; 95% CI 1.54-21.83).


CONCLUSIONS
Our findings of increased risk of ovarian cancer after gonadotropins and of borderline tumors after clomiphene treatment need to be interpreted with caution. However, concern is raised, and further research on the long-term safety particularly of modern hormonal infertility treatment in IVF programs is warranted.
Sanner
Karin
K
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
Conner
Peter
P
Bergfeldt
Kjell
K
Dickman
Paul
P
Sundfeldt
Karin
K
Bergh
Torbjörn
T
Hagenfeldt
Kerstin
K
Janson
Per Olof
PO
Nilsson
Staffan
S
Persson
Ingemar
I
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005300:Fertility Agents, Female / Q000009:adverse effects* / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007247:Infertility, Female / Q000188:drug therapy*; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000139:chemically induced* / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000139:chemically induced* / Q000453:epidemiology*; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
D005300:Fertility Agents, Female