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. Design: Historical cohort study. Setting: Three university hospitals in Sweden. Patient(s): A total of 2,768 women assessed and treated for infertility and infertility-associated disorders between 1961 and 1975. Intervention(s): Exposed women received clomiphene citrate and/or gonadotropins. Main Outcome Measure(s): Incidence of ovarian neoplasia. Result(s): 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). Conclusion(s): 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 modem hormonal infertility treatment in IVF programs is warranted. (Fertil Sterile (R) 2009;91:1152-8. (C) 2009 by American Society for Reproductive Medicine.)