Fertility drug use and the risk of ovarian tumors in infertile women a case control study

Data from a large U.S. case-control study of ovarian tumors revealed no significant association between fertility drug use and the risk of developing ovarian tumors among infertile women.

Albert Asante, M.D., M.P.H., Leonard H. Phoebe, M.D., Amy L. Weaver, Ellen L. Goode, Ph.D., M.P.H., Jani R. Jensen, M.D., Elizabeth A. Stewart, M.D., Charles C. Coddington, M.D.

Volume 99, Issue 7, Pages 2031-2036, June 2013


To assess the influence of infertility and fertility drugs on risk of ovarian tumors.

Case-control study (Mayo Clinic Ovarian Cancer Study).

Ongoing academic study of ovarian cancer.

A total of 1,900 women (1,028 with ovarian tumors and 872 controls, frequency matched on age and region of residence) who had provided complete information in a self-report questionnaire about history of infertility and fertility drug use.


Main Outcome Measure(s):
Effect of infertility history, use of fertility drugs and oral contraception, and gravidity on the risk of ovarian tumor development, after controlling for potential confounders.

Among women who had a history of infertility, use of fertility drugs was reported by 44 (24%) of 182 controls and 38 (17%) of 226 cases. Infertile women who used fertility drugs were not at increased risk of developing ovarian tumors compared with infertile women who did not use fertility drugs; the adjusted odds ratio was 0.64 (95% CI, 0.37, 1.11). The findings were similar when stratified by gravidity and when analyzed separately for borderline versus invasive tumors.

We found no statistically significant association between fertility drug use and risk of ovarian tumors. Further larger, prospective studies are needed to confirm this observation.

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  • Lauren Johnson

    I congratulate the authors on this study, which addresses an important clinical question with robust statistical methods. I am curious about the fertility medications used by the women in the study. Although data was not available for all women, what were the most common medications used among the women who did report specific treatment data? Based on practice patterns in your area, do you think that the subgroup of women whose fertility medications were known are similar to the cohort as a whole?

    • Albert Asante

      Thank you Lauren!
      Great question! As you might have noticed, one of the limitations of our
      study is that 65% of the 82 women who reported using fertility medications did
      not answer the question relating to specific fertility medications used. Valid
      specific fertility medication names were provided by only 30% (25/82). Of this,
      majority (88%) reported using Clomiphene citrate. The two other medications
      that were mentioned were ‘gonadotropins’ (8%) and ‘hcg’ (4%). We did not
      believe that this distribution is representative of the cohort as a whole hence
      our decision not to include this information in the paper, but rather discuss
      it as a significant limitation.
      The subgroup of women who provided information on specific fertility
      medication use differed from those that did not, mainly in terms of age
      (younger), education (more likely to have college or grad school education),
      and non-smoking status (more likely to be nonsmokers). Of note, 72% (18/25)
      were controls.

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