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. 2011 Dec;26(12):3456-65.
doi: 10.1093/humrep/der322. Epub 2011 Oct 26.

Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort

F E van Leeuwen  1 , H Klip, T M Mooij, A M G van de Swaluw, C B Lambalk, M Kortman, J S E Laven, C A M Jansen, F M Helmerhorst, B J Cohlen, W N P Willemsen, J M J Smeenk, A H M Simons, F van der Veen, J L H Evers, P A van Dop, N S Macklon, C W Burger
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Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort

F E van Leeuwen et al. Hum Reprod. 2011 Dec.

Abstract

Background: Long-term effects of ovarian stimulation for IVF on the risk of ovarian malignancies are unknown.

Methods: We identified a nationwide historic cohort of 19,146 women who received IVF treatment in the Netherlands between 1983 and 1995, and a comparison group of 6006 subfertile women not treated with IVF. In 1997-1999, data on reproductive risk factors were obtained from 65% of women and data on subfertility (treatment) were obtained from the medical records. The incidence of ovarian malignancies (including borderline ovarian tumours) through 2007 was assessed through linkage with disease registries. The risk of ovarian malignancies in the IVF group was compared with risks in the general population and the subfertile comparison group.

Results: After a median follow-up of 14.7 years, the risk of borderline ovarian tumours was increased in the IVF group compared with the general population [standardized incidence ratio (SIR) = 1.76; 95% confidence interval (CI) = 1.16-2.56]. The overall SIR for invasive ovarian cancer was not significantly elevated, but increased with longer follow-up after first IVF (P = 0.02); the SIR was 3.54 (95% CI = 1.62-6.72) after 15 years. The risks of borderline ovarian tumours and of all ovarian malignancies combined in the IVF group were significantly increased compared with risks in the subfertile comparison group (hazard ratios = 4.23; 95% CI = 1.25-14.33 and 2.14; 95% CI = 1.07-4.25, respectively, adjusted for age, parity and subfertility cause).

Conclusions: Ovarian stimulation for IVF may increase the risk of ovarian malignancies, especially borderline ovarian tumours. More large cohort studies are needed to confirm these findings and to examine the effect of IVF treatment characteristics.

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Figure 1
Figure 1
Identification of the OMEGA study cohort. aWomen in this category contributed person time till date of questionnaire completion. bIncluding women who returned an empty questionnaire (n = 66) and questionnaires that were returned to sender (n = 656).
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