Skip to main content
SpringerLink
Log in

Fertility drugs and ovarian epithelial cancer: Is there a link?

  • News And Views
  • Reproductive Health Care Policies Around The World
  • Published:
Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Conclusions

It should be noted that citing problems with epidemiologic studies is not the same as disproving their claims. However, it does cast doubt upon the validity and general applicability of their conclusions. The Rossing study strongly suggests an association between ovarian tumors and long-term use of clomiphene citrate. At the same time, it can safely be said that evidence that clomiphene or hMG therapy predisposes the patient to the development of ovarian epithelial carcinoma or any other ovarian tumor is extremely tenuous. Furthermore, there is no consistent physiologic principle (such as “incessant ovulation”) which can be applied to the use of these ovulation-inducing medications to suggest that they would be likely to cause such tumors.

Therefore, physicians administering ovulation-inducing medications and contemplating the ramifications of a possible link between ovarian cancer and fertility medications are left with medicolegal considerations and with the simple principles of prudence and the dictum first to do no harm. As always, patients should be informed and offered alternatives. However, modification of the current practice of ovulation induction or ovarian superovulation on the basis of these epidemiologic studies does not seem warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Morrow CP, Townsend DE: Tumors of the ovary: General considerations; Classification; The adnexal mass.In Synopsis of Gynecologic Oncology, 3rd ed. New York, Wiley & Sons, 1987, pp. 231–255

    Google Scholar 

  2. Piver MS, Baker TR, Piedmonte M, Sandecki AM: Epidemiology and etiology of ovarian cancer. Semin Oncol 1991;18:177–185

    Google Scholar 

  3. Cramer DW: Lactase persistence and milk consumption as determinants of ovarian cancer risk. Am J Epidemiol 1989;130:904–910

    PubMed  Google Scholar 

  4. Mettlin CJ, Piver MS: A case-control study of milk-drinking and ovarian cancer risk. Am J Epidemiol 1990;132:871–876

    PubMed  Google Scholar 

  5. Cramer DW, Welch WR, Scully RE, Wojciechowski CA: Ovarian cancer and talc: A case-control study. Cancer 1982;50:372–376

    PubMed  Google Scholar 

  6. Fathalla MF: Factors in the causation and incidence of ovarian cancer. Obstet Gynecol Surv 1972;27:751–768

    PubMed  Google Scholar 

  7. Bamford PM, Steele SJ: Uterine and ovarian carcinoma in a patient receiving gonadotrophin therapy: Case report. Br J Obstet Gynaecol 1982;89:962–964

    PubMed  Google Scholar 

  8. Atlas M, Menczer J: Massive hyperstimulation and borderline carcinoma of the ovary. Acta Obstet Gynecol Scand 1982;61:261–263

    PubMed  Google Scholar 

  9. Ben-Hur H, Dgani R, Lancet M, Katz Z, Nissim F, Rosenman D: Ovarian carcinoma masquerading as ovarian hyperstimulation syndrome. Acta Obstet Gynecol Scand 1986;65:813–814

    PubMed  Google Scholar 

  10. Carter ME, Joyce DN: Ovarian carcinoma in a patient hyper-stimulated by gonadotropin therapy for in vitro fertilization: a case report. J Vitro Fert Embryo Transfer 1987;4:126–128

    Google Scholar 

  11. Goldberg GL, Runowicz CD: Ovarian carcinoma of low malignant potential, infertility, and induction of ovulation—Is there a link? Am J Obstet Gynecol 1992;166:853–854

    PubMed  Google Scholar 

  12. Nijman HW, Kenemans P: Borderline malignancy of the ovary and controlled hyperstimulation, a report of 2 cases. Eur J Cancer 1992;28A:1971–1973

    PubMed  Google Scholar 

  13. Balasch J, Barri PN: Follicular stimulation an ovarian cancer? Hum Reprod 1993;8:990–996

    PubMed  Google Scholar 

  14. Nasca PC, Greenwald P, Chorost S, Richart R, Caputo T: An epidemiologic case-control study of ovarian cancer and reproductive factors. Am J Epidemiol 1984;119:705–713

    PubMed  Google Scholar 

  15. Joly DJ, Lilienfeld AM, Diamond EL, Bross ID: An epidemiologic study of the relationship of reproductive experience to cancer of the ovary. Am J Epidemiol 1974;99:190–209

    PubMed  Google Scholar 

  16. Whittemore AS, Wu ML, Paffenbarger RS, Sarles DL, Kampert JB, Grosser S, et al.: Epithelial ovarian cancer and the ability to conceive. Cancer Res 1989;49:4047–4052

    PubMed  Google Scholar 

  17. Lais CW, Williams TJ, Gaffey TA: Prevalence of ovarian cancer found at the time of infertility microsurgery. Fertil Steril 1988;49:551–553

    PubMed  Google Scholar 

  18. Whittemore AS, Harris R, Itnyre J, the Collaborative Ovarian Cancer Group: Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. II. Invasive epithelial ovarian cancers in white women. Am J Epidemiol 1992;136:1184–1203

    PubMed  Google Scholar 

  19. Rossing MA, Daling JR, Weiss NS, Moore DE, Self SG: Ovarian tumors in a cohort of infertile women. N Engl J Med 1994;331:771–776

    PubMed  Google Scholar 

  20. Shushan A, Paltiel O, Iscovich J, Elchalal U, Peretz T, Schenker JG: Human menopausal gonadotropin and the risk of epithelial ovarian cancer. Fertil Steril 1996;65:13–18

    PubMed  Google Scholar 

  21. Ron E, Lunenfeld B, Menczer J, Blumstein T, Katz L, Oelsner G,et al. Cancer incidence in a cohort of infertile women. Am J Epidemiol 1987;125:780–790

    PubMed  Google Scholar 

  22. Venn A, Watson L, Lumley J, Giles G, King C, Healy D: Breast and ovarian cancer incidence after infertility and in vitro fertilisation. Lancet 1995;346:995–1000

    PubMed  Google Scholar 

  23. Franceschi S, La Vecchia C, Negri E, Guarneri S, Montella M, Conti E,et al. Fertility drugs and risk of epithelial ovarian cancer in Italy. Hum Reprod 1994;9:1673–1675

    PubMed  Google Scholar 

  24. Honig SC, Lipshultz LI, Jarow J: Significant medical pathology uncovered by a comprehensive male infertility evaluation. Fertil Steril 1994;62:1028–1034

    PubMed  Google Scholar 

Suggested Reading

  1. Schenker JG, Ezra Y: Complications of assisted reproductive techniques. Fertil Steril 1994;61:411–422

    PubMed  Google Scholar 

  2. Shoham Z: Epidemiology, etiology, and fertility drugs in ovarian epithelial carcinoma: Where are we today? Fertil Steril 1994;62:433–448

    PubMed  Google Scholar 

  3. Kaufman SC, Spirtas R, Alexander NJ: Do fertility drugs cause ovarian tumors? J Women's Health 1995;4:247–259

    Google Scholar 

  4. Ron E, Lunenfeld B: A review of infertility and its treatment in the etiology of female reproductive and other cancers. J Women's Health 1995;4:261–272

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles, California

    Richard J. Paulson

Authors
  1. Richard J. Paulson
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

The opinions presented in this column are those of its authors and do not necessarily reflect those of the journal and its editors, publisher, and advertisers.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Paulson, R.J. Fertility drugs and ovarian epithelial cancer: Is there a link?. J Assist Reprod Genet 13, 751–756 (1996). https://doi.org/10.1007/BF02066492

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02066492

Keywords

Search

Navigation