ASRM2015: Increased risk of ovarian cancer observed in women undergoing IVF

Results from a large cohort of women undergoing assisted reproductive technologies (ART) suggest a small increase in the risk of developing ovarian cancer in women who consequently had no children and in women with endometriosis who were treated for infertility.

Ovarian cancer is a serious disease and ART is a common and effective way of managing infertility, so understanding the possible relationship between the two is important for women with endometriosis, where infertility is one of the main symptoms.

Professor Alastair Sutcliffe

Dr Alastair Sutcliffe and his team set out to determine the risk of ovarian cancer, including malignant and borderline ovarian tumours, in women who have been exposed to ART [1].

Of 255,786 women who underwent ART in England, Wales, and Scotland between 1991-2010, 386 ovarian cancers were recorded [2]. This is a 1/3 greater likelihood of developing ovarian cancer compared to the general population of women.

Reproductive factors and risk of ovarian cancer

In a 1995 prospective study of reproductive factors and risk of epithelial ovarian cancer a reduced risk of developing ovarian cancer was observed in women who had given birth [3].

It is therefore perhaps not surprising that women in this British cohort with fewer live births post-ART were at greater risk of developing ovarian cancer, and even more so were those who had no live births after ART. The study also showed that the younger the woman was when she began ART, the greater her risk was of developing ovarian cancer, and the risk of developing cancer was the greatest within the first three years of treatment [1].

However, many factors are associated with a negative outcome from ART, and we don’t know which of these factors may be associated with a potentially higher risk of ovarian cancer.

Finally, the study also showed that women who underwent ART for non-female infertility did not have an increased risk of ovarian cancer [1]. This is reassuring, because it suggests that ovarian cancer is not caused by ART per se; however it does beg the question whether the risk of ovarian cancer is associated with the underlying infertility diagnosis and its potential causes.

How real is the risk of ovarian cancer in women treated for endometriosis-related infertility?

Dr David Adamson

Dr David Adamson, president of the World Endometriosis Research Foundation (WERF) and chair of the International Committee Monitoring Assisted Reproductive Technologies (ICMART), comments:

The finding of an increased association of risk between women who had endometriosis and ART is interesting.

However, it is important to note that this finding does not show cause and effect, that most women with infertility do not undergo ART, and so this study does not address infertility and endometriosis risk in infertile women who have not undergone ART.  Furthermore, this study also does not address the risk in women with endometriosis who suffer from pain and don’t have infertility.

This study, however, is important and helpful in answering some questions and raising others that will require further investigation about infertility, ART, and endometriosis, including analysis by tumour behaviour and histopathological sub-type, as suggested by the authors.

said Dr Adamson.

References
  1. Sutcliffe A et al. Ovarian Tumour risk in women after assisted reproductive therapy (ART); 2.2 million person years of observation in Great Britain. 71st Annual Meeting of the ASRM O-93.
  2. Records from the Human Fertilisation & Embryology Authority (HFEA) of all women who had ART in Britain between 1991-2010, linked to the National Health Service Central Registers (NHSCR) for England, Wales, and Scotland to obtain follow-up for cancer outcomes, deaths, and emigrations (Note that reporting to HFEA is mandatory).
  3. Hankinson SE et al. A prospective study of reproductive factors and risk of epithelial ovarian cancer. Cancer 1995;76:284-90.
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