OVULATION INDUCTION AGENTS AND OVARIAN CANCER
Abstract
Background. Ovarian cancer is the most frequent
cause of death among gynecologic malignancies. Epidemiological
data show that environmental, hormonal and genetic
factors are etiologically significant. Beside the already known
risk factors, ovulation induction agents have been reported as
risk factors in literature since 1986. Over the last two decades,
ovulation induction agents have been widely used in various
assisted reproduction techniques (ART). This study focused
on the question whether in patients receiving ovulation induction
agents the risk for developing pathologic processes on
the ovaries was higher than in those not receiving them, and
whether they were related to the dose and type of ovulation
induction agent.
Methods. In a prospective study 380 subjects were enrolled.
The study group consisted of 280 women who had undergone
an ART procedure three or more times. The control group consisted
of 120 infertile women, never included in an ART procedure.
All the enrolled subjects underwent the same examinations:
a detailed gynecological history was taken, pelvic examination
and vaginal ultrasound were performed, and a blood
sample for tumour marker CA 125 determination was taken.
Statistical analysis was done using Chi-square test, t test and
logistic regression.
Results. Ultrasound examination revealed pathology on the
genital tract in 136 women in the study group and in 60 women
in the control group. Differences in the incidence of ovarian,
tubal and uterine pathology were not statistically significant.
The analysis of the medical records showed that the incidence
of ovarian pathology was significantly higher in the
study than in the control group (p < 0.05). We found no correlation
between the incidence of ovarian pathology and type
or dose of ovulation induction agent. Increased CA 125 levels
were found in 12 women. In none of the women neither malignant
nor borderline malignant disease was found.
Conclusions. Although the analysis of the data from medical
history showed statistically higher incidence of ovarian pathology
in the study than in the control group, clinical, ultrasound
and biochemical examinations of the current health
status showed no difference between the groups. Also, no correlation
between ovarian pathology and type or dose of ovulation
induction agent was found. We believe that the risk of
ovarian malignancy due to ovulation induction agents is very
small. For definitive answers large prospective studies are required.
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