Abstract 736: Exploring the impact of infertility and its treatments on risk of ovarian cancer
Authors: Lee Alice W. , Phung Minh T. , Jensen Allan , Wu Anna H. , Cramer Daniel W. , Modugno Francesmary , Harris Holly , Doherty Jennifer A. , Schildkraut Joellen , Terry Kathryn L. , Moysich Kirsten B. , Pike Malcolm C. , Goodman Marc T. , Webb Penelope M. , Kjaer Susanne K. , Pearce Celeste L. 
Published: June 2022

Abstract
Background: Infertility is related to both nulligravidity and endometriosis, which are both well-established risk factors for ovarian cancer. Infertility is also characterized by various underlying causes and can be treated with different types of fertility drugs. However, most studies to date have been unable to properly address these important issues when examining the infertility-ovarian cancer association due to small numbers of patients and a lack of detailed infertility and risk factor information.
Methods: We pooled self-reported data from 8,324 invasive, epithelial ovarian cancer cases and 13,325 control women in eight population-based case-control studies participating in the Ovarian Cancer Association Consortium (OCAC) to study the infertility-ovarian cancer relationship. Women classified as having a history of infertility were those who had spoken to a doctor about infertility problems or those who had regular sexual intercourse without birth control for a prolonged period (usually one year) without getting pregnant. Cause of infertility as well as use of fertility drugs was examined among those who experienced infertility issues. These associations with risk of ovarian cancer were evaluated using logistic regression models and quantified using odds ratios (ORs) and 95% confidence intervals (CIs). Gravidity and endometriosis were considered in the analyses as well as potential confounding factors.
Results: Overall, infertility was not associated with risk of ovarian cancer (OR=1.02, 95% CI 0.95-1.09). However, women who reported their infertility was due to problems with ovulation or menstruation showed a decreased risk (OR=0.72, 95% CI 0.52-1.01 and OR=0.62, 95% CI 0.43-0.91, respectively) whereas women who reported their infertility was due to endometriosis were at an increased risk (OR=1.54, 95% CI 1.19-1.98). Among women who reported infertility issues, use of fertility drugs was not associated with an increased risk of ovarian cancer regardless of their gravidity status (OR=0.89, 95% CI 0.76-1.05).
Conclusions: The relationship between infertility and risk of ovarian cancer is complex. Although infertility does not appear to be an independent risk factor for ovarian cancer, specific causes of infertility may be differentially associated with ovarian cancer risk, which may shed light on the disease’s underlying etiology. In addition, for women experiencing infertility issues, use of fertility drugs did not show an increased risk of ovarian cancer, which may have important clinical implications.
Citation Format: Alice W. Lee, Minh T. Phung, Allan Jensen, Anna H. Wu, Daniel W. Cramer, Francesmary Modugno, Holly Harris, Jennifer A. Doherty, Joellen Schildkraut, Kathryn L. Terry, Kirsten B. Moysich, Malcolm C. Pike, Marc T. Goodman, Penelope M. Webb, Susanne K. Kjaer, Celeste L. Pearce. Exploring the impact of infertility and its treatments on risk of ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 736.