title: Controlled ovarian hyperstimulation for IVF: impact on ovarian, endometrial and cervical cancer--a systematic review and meta-analysis.
abstract: BACKGROUND
  In response to the ongoing debate on the long-term effects of assisted reproduction technologies, such as IVF, we systematically reviewed and meta-analyzed available evidence on the association between controlled ovarian hyperstimulation for IVF and risk of ovarian, endometrial and cervical cancer.
  
  
  METHODS
  Eligible studies were identified and pooled effect estimates for relative risk (RR) were calculated by cancer type among two reference groups (general population or infertile women), through fixed- or random-effects models as appropriate.
  
  
  RESULTS
  Nine cohort studies were synthesized, corresponding to a total size of 109 969 women exposed to IVF, among whom 76 incident cases of ovarian, 18 of endometrial and 207 cases of cervical cancer were studied. The synthesis of studies with general population as the reference group pointed to a statistically significant positive association between IVF and increased risk for ovarian (RR = 1.50, 95% confidence interval (CI): 1.17-1.92) and endometrial (RR = 2.04, 95% CI: 1.22-3.43), but not cervical (RR = 0.86, 95% CI: 0.49-1.49) cancers. On the contrary, when infertile women were used as the reference group, no significant associations with ovarian, endometrial or cervical cancer types were noted (RR = 1.26, 95% CI: 0.62-2.55 RR = 0.45, 95% CI: 0.18-1.14 and RR = 5.70, 95% CI: 0.28-117.20, respectively).
  
  
  CONCLUSIONS
  IVF does not seem to be associated with elevated cervical cancer risk, nor with ovarian or endometrial cancer when the confounding effect of infertility was neutralized in studies allowing such comparisons. Of note, only one study provided follow-up longer than 10 years for the group exposed to IVF. Future cohort studies should preferably use infertile women as the reference group, rely on IVF-registered valid exposure data, adjust for a variety of meaningful confounders and adopt relatively longer follow-up periods before sound conclusions are drawn.
authors.affiliation: Assisted Reproduction Unit, 3rd Department of Obstetrics and Gynecology,  University of Athens, Attikon Hospital, Chaidari,  Greece.
authors.forename: Charalampos
authors.initials: C
authors.lastname: Siristatidis
authors.forename: Theodoros N
authors.initials: TN
authors.lastname: Sergentanis
authors.forename: Prodromos
authors.initials: P
authors.lastname: Kanavidis
authors.forename: Marialena
authors.initials: M
authors.lastname: Trivella
authors.forename: Marianthi
authors.initials: M
authors.lastname: Sotiraki
authors.forename: Ioannis
authors.initials: I
authors.lastname: Mavromatis
authors.forename: Theodora
authors.initials: T
authors.lastname: Psaltopoulou
authors.forename: Alkistis
authors.initials: A
authors.lastname: Skalkidou
authors.forename: Eleni Th
authors.initials: ET
authors.lastname: Petridou
mesh_terms: D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000453:epidemiology*; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects*; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D012306:Risk; D002583:Uterine Cervical Neoplasms / Q000453:epidemiology*