abstract
OBJECTIVE:
To investigate whether an association exists between a history of fertility treatments and future risk of female malignancies.
STUDY DESIGN:
A
population-based study compared the incidence of long-term female
malignancies in a cohort of women with and without a history of
fertility treatments including in vitro fertilization (IVF) and
ovulation induction (OI). Deliveries occurred between the years
1988-2013, with a mean follow-up duration of 12 years. Excluded from the
study were women with known genetic predisposition for malignancies or
known malignancies prior to the index pregnancy. Female malignancies
were divided into specific types including ovarian, uterine, breast and
cervix. Kaplan-Meier survival curve was used to estimate cumulative
incidence of malignancies. Cox proportional hazard models were used to
estimate the adjusted hazard ratios (HRs) for female malignancy.
RESULTS:
During
the study period, 106,031 women met the inclusion criteria; 4.1 %
(n = 4363) occurred in patients following fertility treatments. During
the follow-up period, patients with a history of IVF treatments had a
significantly increased risk of being diagnosed with ovarian and uterine
cancer as compared to patients after OI and patients with no history of
fertility treatments. Cox proportional hazard models were constructed
for ovarian and uterine cancer separately, controlling for confounders
such as maternal age and obesity. A history of IVF treatment remained
independently associated with ovarian and uterine cancer (adjusted HR
3.9; 95 % CI 1.2-12.6; P = 0.022 and adjusted HR 4.6; 95 % CI 1.4-14.9;
P = 0.011; respectively).
CONCLUSION:
IVF treatments pose a significant risk of subsequent long-term ovarian and uterine cancer.
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