Association between ovarian tumors and exposure to assisted reproductive technologies and ovarian stimulation: a systematic review and meta-analysis

 The question of whether assisted reproductive technologies (ART) and ovulation induction are related to a higher incidence of ovarian tumors (OTs) is still controversial in the literature.

We performed a comprehensive search of PubMed, Embase, and Web of Science databases for case–control and cohort studies that investigated ART and ovulation induction exposure as risk factors for OT in infertile women. Odds ratios (OR) with 95% confidence intervals (CI) were employed for all endpoints.

A total of nine case–control and twelve cohort studies were included, encompassing 439,477 women. ART was not associated with a higher risk of OTs (OR 1.05; 95% CI 0.86–1.29; p = 0.64; I² = 36%), nor when considering only borderline OTs (OR 1.13; 95% CI 0.84–1.51; p = 0.42; I² = 31%). In a subgroup analysis by study type, the risk difference of OTs remained non-significant for case–control (OR 1.12; 95% CI 0.70–1.78; p = 0.65; I² = 60%) and cohort studies (OR 1.05; 95% CI 0.87–1.27; p = 0.60; I² = 1%). For borderline OTs, the difference between groups was also non-significant for case–control studies (OR 1.44; 95% CI 0.73–2.87; p = 0.30; I² = 40%) and cohort studies (OR 1.00; 95% CI 0.75–1.34; p = 0.99; I² = 24%).

In this systematic review and meta-analysis, ART exposure in infertile women was not associated with a higher risk of OTs in general or borderline tumors, even when accounting for study type differences.