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Eur J Epidemiol. 2019 Nov;34(11):1093-1101. doi: 10.1007/s10654-019-00540-3. Epub 2019 Aug 3.

Assisted reproductive technology and risk of ovarian cancer and borderline tumors in parous women: a population-based cohort study.

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Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Cancer Registry of Norway, Oslo, Norway.
Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
Department of Gynecology and Reproduction, Section of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden.
Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, WHO Collaborating Centre, Stockholm, Sweden.


The study aimed to investigate if assisted reproductive technology (ART) treatment or a diagnosis of infertility were associated with the risk of ovarian cancer or borderline ovarian tumors (BOT) in parous women. In a population-based register study of 1,340,097 women with a first live birth in Sweden 1982-2012, the relationship between ART treatments, infertility and incidence of ovarian cancer or BOT were investigated using Cox regression analysis. In the cohort, 38,025 women gave birth following ART, 49,208 following an infertility diagnosis but no ART and 1,252,864 without infertility diagnosis or ART. During follow-up, 991 women were diagnosed with ovarian cancer and 747 with BOT. Women who gave birth following ART had higher incidence of both ovarian cancer (adjusted hazard ratio [aHR] 2.43, 95% confidence interval [CI] 1.73-3.42) and BOT (aHR 1.91, 95% CI 1.27-2.86), compared to women without infertility. Compared to women with infertility diagnoses and non-ART births, women with ART births also had a higher incidence of ovarian cancer (aHR 1.79, 95% CI 1.18-2.71) and BOT (aHR 1.48, 95% CI 0.90-2.44). Our results suggest that women who have gone through ART have a higher risk of ovarian cancer and BOT. At least part of that risk seems to be due to the underlying infertility and not the treatment per se, since the increased risk was smaller when comparing to other infertile women. As ART treatments are becoming more common and ovarian cancer usually occur in women of advanced age, larger studies with longer follow-up are needed in order to confirm or refute our findings.


Assisted reproductive technology; Borderline ovarian tumor; In vitro fertilization; Infertility; Ovarian cancer; Ovarian stimulation

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