Ovulation-inducing drugs and ovarian cancer risk: results from an extended follow-up of a large United States infertility cohort.

Abstract

OBJECTIVE:

To examine the relationship of ovulation-inducing drugs and ovarian cancer.

DESIGN:

Retrospective cohort study, with additional follow-up since initial report.

SETTING:

Five large reproductive endocrinology practices.

PATIENT(S):

In a retrospective cohort of 9,825 women evaluated for infertility at five clinical sites in the United States between 1965 and 1988 with follow-up through 2010, we examined the relationship of ovulation-inducing drugs and ovarian cancer (n = 85).

INTERVENTION(S):

None.

MAIN OUTCOME MEASURE(S):

Hazard rate ratios (RR) and 95% confidence intervals (CI) for ovarian cancer.

RESULT(S):

Among women evaluated for infertility, there was no association of ovarian cancer risk with ever use of clomiphene citrate (CC) (adjusted RR 1.34, 95% CI 0.86-2.07) or gonadotropins (RR 1.00, 95% CI 0.48-2.08) and no evidence that any of several more detailed subgroups of usage were related to an increased risk with one exception: women who used CC and remained nulligravid did demonstrate much higher risks than those who successfully conceived compared with nonusers (respectively, RR 3.63, 95% CI 1.36-9.72 vs. RR 0.88, 95% CI 0.47-1.63).

CONCLUSION(S):

Our overall results were reassuring and consistent with other studies. A reason for an association between CC use and ovarian cancer among persistently nulligravid women remains to be determined. Given the large and increasing number of women treated with ovulation-inducing drugs, the increased risk of ovarian cancer among the subset of women who remained nulligravid should be further monitored.

• Authors: Britton Trabert, Emmet J Lamb, Bert Scoccia, Kamran S Moghissi, Carolyn L Westhoff, Shelley Niwa, Louise A Brinton
• Journal: Fertility and sterility (Fertil Steril) Vol. 100 Issue 6 Pg. 1660-6 (Dec 2013) ISSN: 1556-5653 [Electronic] United States
• PMID: 24011610 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Intramural)
• Copyright: Published by Elsevier Inc.

Chemical References

• Fertility Agents, Female
• Gonadotropins
• Clomiphene

Topics

• Adult
• Causality
• Clomiphene (administration & dosage)
• Cohort Studies
• Comorbidity
• Drug-Related Side Effects and Adverse Reactions (epidemiology)
• Female
• Fertility Agents, Female (administration & dosage)
• Follow-Up Studies
• Gonadotropins (administration & dosage)
• Humans
• Incidence
• Infertility, Female (epidemiology, therapy)
• Middle Aged
• Ovarian Neoplasms (epidemiology)
• Ovulation Induction (statistics & numerical data)
• Retrospective Studies
• Risk Factors
• Treatment Outcome
• United States (epidemiology)