Ovulation induction and ovarian malignancy

Many couples faced with infertility are treated with ovulation inducing medicines. Recently, concerns have been raised about the possible risk of ovarian malignancy after such ovarian stimulation. Theories of pathogenesis for ovarian cancer include incessant ovulation, elevated pituitary gonadotropins, genetic predisposition, and chemical carcinogens. Protective factors include suppression of ovulation, pregnancy, and castration. Low numbers of exposed women who develop ovarian cancer make this a difficult research subject. Research to date demonstrates conflicting results, with some investigators reporting an increased risk of ovarian cancer with fertility drugs, whereas others do not. The likely magnitude of risk, if one believes a risk exists, may be two to three times that of the general population which is at most 4-5% in a woman's lifetime. The present uncertainty makes it challenging to apply this to today's practice of medicine. With continued efforts worldwide, we hope an understanding of this will be forthcoming.