title: In vitro fertilization, endometriosis, nulliparity and ovarian cancer risk.
abstract: OBJECTIVE
  To examine the risk of invasive epithelial ovarian cancer in a cohort of women seeking treatment for infertility.
  
  
  METHODS
  Using whole-population linked hospital and registry data, we conducted a cohort study of 21,646 women commencing hospital investigation and treatment for infertility in Western Australia in the years 1982-2002. We examined the effects of IVF treatment, endometriosis and parity on risk of ovarian cancer and explored potential confounding by tubal ligation, hysterectomy and unilateral oophorectomy/salpingo-oophorectomy (USO).
  
  
  RESULTS
  Parous women undergoing IVF had no observable increase in the rate of ovarian cancer (hazard ratio [HR] 1.01; 95% confidence interval [CI] 0.35-2.90); the HR in women who had IVF and remained nulliparous was 1.76 (95% CI 0.74-4.16). Women diagnosed with endometriosis who remained nulliparous had a three-fold increase in the rate of ovarian cancer (HR 3.11; 95% CI 1.13-8.57); the HR in parous women was 1.52 (95% CI 0.34-6.75). In separate analyses, women who had a USO without hysterectomy had a four-fold increase in the rate of ovarian cancer (HR 4.23; 95% CI 1.30-13.77). Hysterectomy with or without USO appeared protective.
  
  
  CONCLUSIONS
  There is no evidence of an increased risk of ovarian cancer following IVF in women who give birth. There is some uncertainty regarding the effect of IVF in women who remain nulliparous. Parous women diagnosed with endometriosis may have a slightly increased risk of ovarian cancer; nulliparous women have a marked increase in risk.
authors.affiliation: School of Population Health, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, M431, 35 Stirling Highway, Crawley, WA 6009, Australia. louise.stewart@uwa.edu.au
authors.forename: Louise M
authors.initials: LM
authors.lastname: Stewart
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
authors.forename: Patrick
authors.initials: P
authors.lastname: Aboagye-Sarfo
authors.forename: Judith C
authors.initials: JC
authors.lastname: Finn
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
authors.forename: Roger
authors.initials: R
authors.lastname: Hart
mesh_terms: D000328:Adult; D000077216:Carcinoma, Ovarian Epithelial; D015331:Cohort Studies; D004715:Endometriosis / Q000453:epidemiology*; D005260:Female; D005307:Fertilization in Vitro / Q000706:statistics & numerical data*; D006801:Humans; D007044:Hysterectomy / Q000706:statistics & numerical data; D007247:Infertility, Female / Q000453:epidemiology; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000453:epidemiology*; D010051:Ovarian Neoplasms / Q000453:epidemiology*; D010052:Ovariectomy / Q000706:statistics & numerical data; D010298:Parity; D012042:Registries; D012307:Risk Factors; D014904:Western Australia / Q000453:epidemiology