What are the risks of ovulation induction?

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BMJ. 2009 Feb 5;338:b249. doi: 10.1136/bmj.b249.

Use of fertility drugs and risk of ovarian cancer: Danish Population Based Cohort Study.
Jensen A, Sharif H, Frederiksen K, Kjaer SK.

Danish Cancer Society, Institute of Cancer Epidemiology, Strandboulevarden 49, DK-2100, Copenhagen, Denmark. allan@cancer.dk

Objective:

To examine the effects of fertility drugs on overall risk of ovarian cancer using data from a large cohort of infertile women.

Design:

Population based cohort study.

Setting:

Danish hospitals and private fertility clinics. PARTICIPANTS: 54,362 women with infertility problems referred to all Danish fertility clinics during 1963-98. The median age at first evaluation of infertility was 30 years (range 16-55 years), and the median age at the end of follow-up was 47 (range 18-81) years. Included in the analysis were 156 women with invasive epithelial ovarian cancer (cases) and 1241 subcohort members identified in the cohort during follow-up in 2006. MAIN OUTCOME MEASURE: Effect of four groups of fertility drugs (gonadotrophins, clomifene citrate, human chorionic gonadotrophin, and gonadotrophin releasing hormone) on overall risk of ovarian cancer after adjustment for potential confounding factors.

Results:

Analyses within cohort showed no overall increased risk of ovarian cancer after any use of gonadotrophins (rate ratio 0.83, 95% confidence interval 0.50 to 1.37), clomifene (1.14, 0.79 to 1.64), human chorionic gonadotrophin (0.89, 0.62 to 1.29), or gonadotrophin releasing hormone (0.80, 0.42 to 1.51). Furthermore, no associations were found between all four groups of fertility drugs and number of cycles of use, length of follow-up, or parity. CONCLUSION: No convincing association was found between use of fertility drugs and risk of ovarian cancer.

Please click on the required question.

• 1 What are the objectives of infertility treatment?
• 2 Why have I been advised to take folic acid as part of my infertility treatment?
• 3  Although my ovaries have eggs in them, my tests show that I am not releasing them (anovulation) and this is causing infertility. How can this be treated?
• 4 If I take drugs to induce ovulation (ovulation induction) for my infertility, are there any risks?
• 5 How is ovulation induction treatment for infertility monitored?
• 6 How does clomiphene citrate work for infertility?
• 7  How effective is clomiphene in the treatment of infertility?
• 8 Could I experience any problems whilst taking clomiphene?
• 9 Is there any advantage in having an injection of HCG to ensure ovulation?
• 10 How does tamoxifen work?
• 11 How can hyperprolactinaemia be treated?
• 12 How does metformin work?
• 12A How does letrozole work for infertility?
• 13 How do gonadotrophins work?
• 14 What are the risks for me if I receive gonadotrophin therapy?
• 15 What are recombinant gonadotrophins?
• 16  What is ovarian hyperstimulation syndrome (OHSS)
• 17 How is ovarian hyperstimulation syndrome treated?
• 18 How does electrocautery (ovarian drilling) work for infertility associated with polycystic ovary syndrome (PCOS)
• 19 I have been found to have endometriosis. How should this be treated to improve my chance of conceiving?
• 20 Tests have shown that I have problems with my Fallopian tubes. What can be done about this?
• 21 I have fibroids. How should these be treated to improve my fertility?
• 22 My post-coital test has shown that my mucus is stopping the sperm from swimming (mucus hostility). What can be done?
• 23 When can intrauterine insemination (IUI) improve our chance of achieving a pregnancy?
• 24 What is in vitro fertilisation (IVF) and embryo transfer (ET)
• 24A IVF single or double embryo transfer?
• 25 What is intracytoplasmic sperm injection (ICSI)
• 26 How do tubal surgery and IVF compare?
• 27 What are egg donation and egg sharing?
• 28 What is selective embryo transfer?
• 29 Investigations have shown no obvious cause for our difficulty achieving a pregnancy. Are there any treatments for our unexplained infertility?
• 30 We have tried a variety of treatments but we still have not achieved a pregnancy. Why should this be?
• 31  We are finding the investigation and treatment of our fertility problems to be ever more stressful. Can stress be a cause of infertility?
• 32 How can we determine which fertility unit is likely to be the best for us?
• 33 Where can I obtain more information?
• 34 Support Groups.
  

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London - Specialist Interests - Reproductive Medicine including Infertility, PCOS, PMS, Menopause and HRT.

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