Fertility Drugs And Cancer

Publication Date: December 1, 2016
Last Updated: March 14, 2022

Summary

The data assessing the association between fertility drugs and cancer are limited and principally come from observational studies. (, )
(Level 2-2 or lower)
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Methodological issues include small sample sizes, heterogeneous treatment regimens, inadequate information about duration and dose of treatment, retrospective analyses, and short follow-up periods. (, )
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Overall, there is fair evidence that women with infertility have an increased risk of breast, ovarian, and endometrial cancer. (, B)
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Based on available data, we can be reasonably reassured that there is no meaningful increased risk of invasive ovarian cancer following the use of fertility drugs in infertile women. (, B)
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Based on the available data there is fair evidence that the risk of invasive ovarian cancer is not different with one fertility drug compared with another. (, B)
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While several studies have shown a small increase in the absolute risk of borderline tumors after fertility treatments, there is insufficient consistent evidence that a particular fertility drug increases the risk of borderline ovarian tumors. (, C)
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It is important to note that any absolute increase in risk is small, and borderline ovarian tumors are indolent and generally have a favorable prognosis. (, B)
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There is fair evidence that fertility drugs are not associated with an increased risk of breast cancer. (, B)
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Overall, there is fair evidence that fertility drugs are not associated with an increased risk of endometrial cancer. (, B)
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Overall, there is fair evidence that fertility drugs are not associated with an increased risk of invasive thyroid cancer. (, B)
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Overall, there is insufficient evidence that fertility drugs are associated with an increased risk of melanoma. (, C)
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Overall, there is fair evidence that fertility drugs are not associated with an increased risk of colon cancer. (, B)
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Based on a single study, there is insufficient evidence that fertility drugs are associated with an increased risk of lymphoma. (, C)
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Overall, there is fair evidence that fertility drugs are not associated with an increased risk of cervical cancer. (, B)
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Recommendations

Given the available literature, patients should be counseled that infertile women may be at an increased risk of invasive ovarian, endometrial, and breast cancer; however, use of fertility drugs does not appear to increase this risk. (, )
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While several studies have shown a small increase in the absolute risk of borderline ovarian tumors after fertility treatments, there is insufficient consistent evidence that a particular fertility drug increases the risk of borderline ovarian tumors. (, )
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It is important to note that borderline ovarian tumors are indolent and generally have a favorable prognosis, and any absolute increase in risk related to fertility drugs is small. Therefore, there is insufficient evidence to recommend against the use of fertility medications to avoid borderline ovarian tumors. (, )
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Recommendation Grading

Overview

Title

Fertility Drugs And Cancer

Authoring Organization

American Society for Reproductive Medicine

Publication Month/Year

December 1, 2016

Last Updated Month/Year

January 16, 2024

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The use of fertility drugs that may cause alterations in endogenous hormones and multiple ovulations has raised concerns about the long-term safety of such medications. Although some clinical studies have suggested a link between fertility drugs and the risk of cancer, the results of these studies are difficult to interpret. 

Target Patient Population

Patients receiving fertility drugs

Inclusion Criteria

Female, Adult

Health Care Settings

Ambulatory, Laboratory services, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Prevention, Management

Diseases/Conditions (MeSH)

D005299 - Fertility Agents, D005300 - Fertility Agents, Female

Keywords

cancer, fertility, infertility