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Evidence summaries

Risk of Ovarian Cancer Associated with Ovulation Induction

Women who have had ovulation induction for infertility might have a slightly increased risk for ovarian cancer compared with general population or subfertile women without ovulation induction. Level of evidence: "D"

A Cochrane review [Abstract] 2 included 13 case-control studies and 24 cohort studies with a total of4 684 724 women. Two cohort studies reported an increased incidence of invasive ovarian cancer in exposed subfertile women compared with unexposed women. The slight increase in ovarian cancer risk among women having between 1 and 3 cycles of in vitro fertilisation (IVF) was reported, but this was not clinically significant (P = 0.18). There was no increase in risk of invasive ovarian cancer after use of infertility drugs in women with the BRCA mutation according to one cohort and one case-control study.

Another Cochrane review [Abstract] 1 included 19 observational studies with a total of 1 937 880 participants. Overall, the quality of evidence was very low. Subfertile women with exposure to any ovary-stimulating drug did not have an increased risk of endometrial cancer compared with subfertile women without the exposure T1. An increased risk was found after exposure to any ovary-stimulating drug compared with general population without an exposure T1.

Exposure to ovary-stimulating drugs for subfertility compared to untreated subfertile women and endometrial cancer risk

Outcome in all: Endometrial cancer Treatment and comparisonRelative effect RR (95% CI)Risk with no treatmentRisk with intervention (95% CI)of participants(studies)
Any ovary-stimulating drug for subfertilityComparison: Untreated subfertile womenRR 0.96(0.67 to 1.37)111 per 100 000109 per 100,000(74 to 163)156 774(6)
Any ovary-stimulating drug for subfertilityComparison: General populationRR 1.75(1.18 to 2.61)53 per 100 00092 per 100 000(62 to 138)1 762 829(15)
Clomiphene citrate for subfertilityComparison: Untreated subfertile womenRR 1.32(1.01 to 1.71)524 per 100 000691 per 100 000(530 to 894)92 849(5)
Clomiphene citrate for subfertilityComparison: General populationRR 1.87(1.00 to 3.48)284 per 100 000529 per 100 000(284 to 980)19 614(4)
Gonadotropins for subfertilityComparison: Untreated subfertile womenRR 1.55(1.03 to 2.34)1291 per 100 0001987 per 100 000(1329 to 2970)17 769(4)
Gonadotropins for subfertilityComparison: General populationRR 2.12(0.79 to 5.64)542 per 100 0001148 per 100 000(428 to 3054)1 595(2)
Clomiphene citrate and gonadotropins for subfertilityComparison: Untreated subfertile womenRR 1.18(0.57 to 2.44)490 per 100 000579 per 100 000(279 to 1196)6 345(2)
Clomiphene citrate and gonadotropins for subfertilityComparison: General populationRR 2.99(1.53 to 5.86)76 per 100 000245 per 100 000(150 to 401)7 789(3)
GnRH analogues for subfertilityComparison: Untreated subfertile womenRR 1.21(0.65 to 2.27)458 per 100 000554 per 100 000(297 to 1039)42 558(2)

Comment: The quality of evidence is downgraded by study quality.

    References

    • Rizzuto I, Behrens RF, Smith LA. Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility. Cochrane Database Syst Rev 2019;(6):CD008215. [PubMed]
    • Skalkidou A, Sergentanis TN, Gialamas SP et al. Risk of endometrial cancer in women treated with ovary-stimulating drugs for subfertility. Cochrane Database Syst Rev 2017;(3):CD010931. [PubMed]

Primary/Secondary Keywords