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Challenge: Counseling women about the risks of cancer from ovarian stimulation.

Background:

 Nulliparity is a risk factor for breast, ovarian and endometrial cancers.

 Infertility and associated comorbidities may act as a risk factor for many gynecological cancers.

 PCOS, a condition associated with infertility, is linked to endometrial cancer but not with breast cancer.

 It is difficult to separate the cancer risks attributable to infertility from that of fertility drugs.

 Most epidemiologic studies that have examined the association between fertility drugs and cancer risks have used the general population as the comparator. A more appropriate comparator is the untreated infertile population as this would allow better assessment of the cancer risk attributable to fertility drugs.

 Some studies have shown a small increase in the risk of borderline ovarian tumors following the use of fertility drugs, but the evidence is insufficient to recommend against their use.

Management options:

 Women should be counseled about the uncertainty in the available evidence.

 Women may be counseled that there is no clear evidence that the use of fertility drugs for IVF increases the risk of cancers.