Original Article
Ovarian Tumors in a Cohort of Infertile Women
N Engl J Med 1994; 331:771-776September 22, 1994
- Abstract
Background
Case reports and the results of a recent case-control study have raised questions about the potential neoplastic effects of medications used as treatment for infertility.
Methods
We examined the risk of ovarian tumors in a cohort of 3837 women evaluated for infertility between 1974 and 1985 in Seattle. Computer linkage with a population-based tumor registry was used to identify women in whom tumors were diagnosed before January 1, 1992. Data on infertility testing and treatment were abstracted from the medical records of women who had ovarian cancer and those of a randomly selected comparison group. The risk of ovarian tumors associated with exposure to ovulation-inducing medications was assessed through an age-standardized comparison with the rate of ovarian tumors in the general population, and Cox regression analysis was used to compare the risk of cancer among women who received these medications with the risk among infertile women who did not receive them.
Results
There were 11 invasive or borderline malignant ovarian tumors, as compared with an expected number of 4.4 (standardized incidence ratio, 2.5; 95 percent confidence interval, 1.3 to 4.5). Nine of the women in whom ovarian tumors developed had taken clomiphene; the adjusted relative risk among these women, as compared with that among infertile women who had not taken this drug, was 2.3 (95 percent confidence interval, 0.5 to 11.4). Five of the nine women had taken the drug during 12 or more monthly cycles. This period of treatment was associated with an increased risk of ovarian tumors among both women with ovarian abnormalities and those without apparent abnormalities (relative risk, 11.1; 95 percent confidence interval, 1.5 to 82.3), whereas treatment with the drug for less than one year was not associated with an increased risk.
Conclusions
Prolonged use of clomiphene may increase the risk of a borderline or invasive ovarian tumor.
Media in This Article
Table 1
Characteristics of the Cohort of 3837 Infertile Women.Table 2
Selected Characteristics of the Subcohort of Infertile Women and the Women with Ovarian Tumors.Article Activity
- Article
Case reports of ovarian tumors in women undergoing infertility treatment have raised questions about the potential neoplastic effects of ovulation-inducing agents used in the treatment of infertility1-3. A recent analysis of 12 U.S. case-control studies reported increased risks of malignant epithelial ovarian cancer,4 borderline epithelial ovarian tumors,5 and nonepithelial ovarian cancer6 in association with the use of fertility drugs.
We performed a case-cohort study to determine whether infertile women have an increased risk of ovarian tumors and, if so, whether that risk is influenced by the apparent cause of the infertility or the treatment received for it.
Methods
Cohort Identification
The cohort was composed of 3837 women evaluated for infertility at participating clinics in Seattle between January 1, 1974, and December 31, 1985. The members of the cohort met the following eligibility criteria: at the time of the evaluation, they resided in the 13-county area of western Washington covered by the Cancer Surveillance System (CSS), a population-based tumor registry operating as part of the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute; they had attempted conception for a period of at least one year; and they had made at least two visits to an infertility clinic participating in the study.
Ascertainment of Cases of Cancer
Identifying information, including name, address, date of birth, and social security number, was collected for each member of the cohort from the records of the infertility clinic where she was evaluated. These data were linked by computer to CSS records to identify women who received a diagnosis of cancer after enrollment in the study and before January 1, 1992. In addition to ascertaining all tumors considered reportable by SEER, since 1974 the CSS has ascertained ovarian tumors of low malignant potential. Also known as borderline ovarian tumors, these neoplasms exhibit some features of cancer and may metastasize but are not invasive7.
Subcohort Selection
A comparison group of 135 women were randomly selected from the cohort in four strata for age at the time of enrollment (<25, 25 to 29, 30 to 34, and ≥ 35 years old) and in three strata for the period of enrollment (1974 through 1977, 1978 through 1981, and 1982 through 1985). For each stratum, the number of women selected was three times as large as the number of women with the most common type of cancer in that stratum.
Ascertainment of Exposure
We reviewed the clinic records of the women with ovarian tumors and the members of the subcohort. The results of this review and the treating physician's interpretation of the results of infertility tests, including the basal body temperature, hysterosalpingography, the postcoital test, analysis of the partner's semen, endometrial biopsy, and laparoscopy, were used to classify the causes of infertility. Information on the menstrual, contraceptive, and reproductive history was also collected, as well as the dosages and types of medications received for the treatment of infertility and the dates of the treatment.
The classification of ovulatory abnormalities was based on the presence of abnormal menstrual cycles (a pattern other than regular cycles of 21 to 35 days) recorded at the time of enrollment in the cohort or on the presence of an abnormality in the basal body temperature (according to the treating physician's interpretation of this test) at a time when no medication was being administered for infertility. Ovulatory infertility was classified as amenorrhea (no menstruation without medication or a period of 6 months or longer between cycles), oligomenorrhea (36 to 180 days between cycles), anovulation (no shift in the basal body temperature, as noted by the physician), or a luteal-phase defect (an elevated temperature for less than 11 days or an abnormal pattern of temperature elevation, as noted by the physician). In addition, we assessed the risk of cancer among the women with polycystic ovaries diagnosed by a physician.
Abnormalities of the fallopian tubes were documented on the basis of evidence of such abnormalities on the hysterosalpingogram or at laparoscopy or laparotomy. Endometriosis was documented on the basis of evidence of this condition at laparoscopy or laparotomy. Male-factor infertility was defined as a minimum of two semen analyses with abnormal results or an abnormal sperm-penetration assay, or a previous vasectomy in the male partner.
Calculation of the Period at Risk
In general, the date of enrollment in the cohort was the date of the second visit to the clinic. However, if a woman had visited a clinic two or more times before one year of attempted conception had elapsed, then the enrollment date was the date of the first visit after one year of attempted conception. If the evaluation of infertility began before 1974, the date of enrollment was the date of the first visit to the clinic in 1974.
To determine whether cohort members were still residing in the CSS area at the end of the follow-up period, a computer-generated list of licensed drivers in Washington State in 1991 was matched to the cohort. For the women not listed as licensed drivers in the state, other procedures were used to determine whether they had moved, including credit-bureau tracings and searches of the National Death Index.
For women residing in the CSS area, the period at risk was calculated as the time from enrollment in the cohort to the end of the study (December 31, 1991). For the women who had moved, the end of the follow-up period was considered to be the first date at which each was known to be residing outside the study area. For the women who died during the study, the end of the follow-up period was considered to be the date of death. Women who were not located were assumed to have remained in the area until the end of the study.
Statistical Analysis
Age-standardized incidence ratios were calculated to compare the rates of cancer in the cohort with those in the general population of the CSS area. The stratified ratio method8 was used to calculate the expected numbers of cancers in subgroups of the cohort, with age-specific cancer rates reported by the CSS from 1974 to 1991. Fisher's exact 95 percent confidence intervals9 were calculated for the age-standardized incidence ratios.
For within-cohort analyses, Cox regression analysis (with age as the time axis) was used to estimate relative risks and 95 percent confidence intervals, with the necessary adjustment of the variance estimates due to cohort sampling10-12. Potential confounding factors investigated included parity, gravidity, use of oral contraceptives, age at the birth of the first child, body weight (all assessed at the time of enrollment in the cohort), age at menarche, and type of infertility. Because ovulation-inducing drugs were used primarily during follow-up, such use was treated as a time-dependent variable.
Cohort Follow-up
The women ranged in age from 17 to 44 years at the time of enrollment and contributed 43,438 person-years of observation. Nearly all the women (96.6 percent) were under 50 years of age at the end of follow-up (Table 1Table 1
Characteristics of the Cohort of 3837 Infertile Women.). Most (85 percent) were still residing in the CSS area at the end of the study; 10.9 percent were located outside the study area. Only 0.5 percent of the women were known to have died, and 3.6 percent could not be traced. The social security numbers were unknown for one third of the untraced women -- a considerably larger proportion than that of the whole cohort (4.4 percent).Results
Eleven women were identified as having invasive or borderline malignant ovarian tumors. A variety of histologic types were reported, including four invasive epithelial tumors (two mucinous cystadenocarcinomas, one endometrioid carcinoma, and one adenocarcinoma); five borderline epithelial tumors (two mucinous cystadenomas, two papillary serous cystadenomas, and one papillary mucinous cystadenoma of low malignant potential); and two granulosa-cell tumors. Tumors were diagnosed an average of 6.9 years after enrollment in the cohort (range, 1.8 to 16.4). The 11 women ranged in age from 24 to 43 years at the time of the diagnosis (median, 39).
The risk of cancer (at all anatomical sites, in situ tumors excluded) in the cohort was similar to that in the female population of western Washington (age-standardized incidence ratio, 0.9; 95 percent confidence interval, 0.7 to 1.2; 58 observed cases occurring vs. 62.5 expected cases). The relative risk of an ovarian tumor was 2.5 (95 percent confidence interval, 1.3 to 4.5). Although the risk of an invasive epithelial ovarian tumor was somewhat increased (age-standardized incidence ratio, 1.5; 95 percent confidence interval, 0.4 to 3.7), the risk of a borderline tumor was substantially higher than that expected on the basis of rates in the general population of women (age-standardized incidence ratio, 3.3; 95 percent confidence interval, 1.1 to 7.8).
Abnormalities of ovulation and male-factor infertility were the most common causes of infertility in the subcohort (Table 2Table 2
Selected Characteristics of the Subcohort of Infertile Women and the Women with Ovarian Tumors.). Although treatment with clomiphene citrate was most common among the women with ovulatory abnormalities (85.4 percent, n = 41), more than half the women without such abnormalities had taken this medication (52.9 percent, n = 46). Approximately one fourth of the subcohort received human chorionic gonadotropin, whereas only 4.4 percent received human menopausal gonadotropin. Among the women using clomiphene, the duration of treatment was unknown for five subcohort members and one woman with an ovarian tumor.In the subcohort, the women who used clomiphene (and in particular those who used it for at least 12 menstrual cycles) were less likely than the nonusers to have been pregnant before enrollment in the cohort. While under care for infertility, the women with no exposure to fertility drugs were less likely to become pregnant during treatment (35.4 percent); however, similar proportions of short-term users (1 to 11 cycles, 50.0 percent) and long-term clomiphene users ( ≥ 12 cycles, 55.6 percent) became pregnant. The women who used clomiphene were more likely than the unexposed women to have ovulatory abnormalities (47.1 percent vs. 14.9 percent). Male-factor infertility and endometriosis were more common among the long-term users than among the short-term users of clomiphene (50.0 percent vs. 29.7 percent and 38.9 percent vs. 15.6 percent, respectively). Among the short-term users, the most common type of infertility was an ovulatory abnormality (diagnosed in 51.6 percent of the short-term users, as compared with 33.3 percent of the long-term users).
Both the women with infertility due to ovulatory abnormalities and those with infertility due to other causes were at increased risk for ovarian tumors, as compared with the general population of women in western Washington (Table 3Table 3
Risk of Ovarian Tumors in the Cohort of Infertile Women, as Compared with Rates of Ovarian Tumors in the General Population of Western Washington, According to the Type of Abnormality and Use of Medications for Infertility.). The women who had used clomiphene or other ovulation-induction agents were at increased risk (age-standardized incidence ratio associated with clomiphene use, 3.1), whereas little increase in risk was observed among women with no history of exposure to these drugs (age-standardized incidence ratio, 1.4).Ovarian tumors were roughly twice as likely to develop in the women with ovulatory abnormalities as in the infertile women with other types of abnormalities (Table 4Table 4
Relative Risk of Ovarian Tumors Associated with Ovulatory Abnormalities in the Cohort of Infertile Women.). Adjustment for the duration of clomiphene use resulted in a slightly reduced estimate of the relative risk. There was no clear association between the risk of a tumor and a particular type of ovulatory infertility.Ovarian tumors developed in nine of the women who had used clomiphene, resulting in a higher risk than that among infertile women who had never used the drug (Table 5Table 5
Relative Risk of Ovarian Tumors Associated with Use of Ovulation-Inducing Drugs in the Cohort of Infertile Women.). When we examined the risk associated with the duration of use, we noted no increase in the risk associated with the use of clomiphene for less than 12 menstrual cycles, whereas the women who used the drug for 12 or more cycles were at considerably increased risk (adjusted relative risk, 11.1; 95 percent confidence interval, 1.5 to 82.3). Adjustment for the presence of ovulatory abnormalities reduced the relative risk associated with the use of clomiphene for 12 or more cycles from 11.1 to 7.7 (95 percent confidence interval, 1.0 to 60.1), whereas adjustment for weight increased the risk to 18.0 (95 percent confidence interval, 1.4 to 230.1). Among the long-term users of clomiphene in the subcohort, the median number of cycles of use was 16 (range, 12 to 45); among comparable women with ovarian tumors, the median number of cycles of use was 17 (range, 12 to 20).Among the women with no apparent ovulatory abnormalities, the risk (adjusted only for age and year of enrollment in the cohort) of ovarian tumors associated with the use of clomiphene for ≥ 12 cycles, as compared with the risk associated with clomiphene use for 0 to 11 cycles, was 9.1 (95 percent confidence interval, 1.0 to 86.5); among the women with ovulatory abnormalities, the relative risk associated with long-term use was 7.4 (95 percent confidence interval, 1.0 to 53.1). Among nulligravid women, the risk of ovarian tumors associated with the use of clomiphene for ≥ 12 cycles, as compared with the risk associated with clomiphine use for 0 to 11 cycles, was 10.8 (95 percent confidence interval, 1.5 to 77.9), whereas among gravid women, the relative risk was 17.0 (95 percent confidence interval, 1.2 to 242.8).
There was no increase in the risk of ovarian tumors associated with the use of human chorionic gonadotropin when case patients were compared with subcohort members (adjusted relative risk, 1.0; 95 percent confidence interval, 0.2 to 4.3). Furthermore, we observed no trend in the risk associated with the duration of treatment (data not shown). The median duration of treatment among both case patients and subcohort members was 3.0 months. Because of the low prevalence of exposure to other drugs that induce ovulation, we did not estimate the relative risks associated with their use.
Discussion
Our study had a number of limitations, among which was the imprecision of our estimate of the number of person-years of risk for the occurrence of ovarian tumors among women in western Washington. Most of the women in the cohort (72 percent) were identified as residents of the study area on the basis of 1991 records of licensed drivers in Washington State. Women identified as living in western Washington on the basis of credit tracing were also considered residents of the study area. In addition, we included the small proportion of unlocated cohort members (3.6 percent) as residents of western Washington. To the extent that we have overestimated the years during which cohort members resided in western Washington, we have overestimated the expected number of ovarian tumors occurring in the cohort. Such an overestimation would result in an underestimation of age-standardized incidence ratios.
An additional potential source of error is the occurrence of oophorectomy among cohort members. If the proportion of women in the cohort who underwent this procedure was higher or lower than that in the general population, the comparisons with population rates are biased. Also, if certain subgroups of infertile women (e.g., those with ovulatory abnormalities or those who had taken clomiphene) underwent oophorectomy more frequently or less frequently than did other infertile women, our within-cohort comparisons may also be affected.
In some instances, particularly in the case of women whose surnames had changed and whose social security numbers were unknown, we may have failed to match cohort members correctly to CSS records. However, given the small proportion of cohort members with unknown social security numbers (and the high proportion of CSS records containing social security numbers), we expect that a minimal proportion of tumors occurring among cohort members residing in the study area were not identified.
Some of the infertile women did not undergo all the diagnostic procedures, and some of these women may have had unrecognized abnormalities. Such a misclassification would be likely to be nondifferential (i.e., occurring to an equal extent in cases and noncases) and would reduce our ability to observe a relation between the risk of tumor and a particular type of abnormality.
Women may receive ovulation-inducing drugs from more than one doctor. In general, information about prior treatment at infertility clinics not participating in the study was available in the medical charts, although a small proportion of the women had taken clomiphene for an unknown period before enrollment in the cohort. Also, some women may have initiated treatment at a new clinic after undergoing treatment at a study clinic. Information not contained in the medical records or concerning events that occurred after the evaluation for infertility at the study clinics was not available for this analysis.
Only a small number of tumors developed during the follow-up period, limiting the precision of our risk estimates. Also, our ability to examine the relation between the risk of cancer and specific types of ovulatory abnormalities and between the use of clomiphene and histologic subtypes of tumors is limited.
The relatively long interval between enrollment in the cohort and the diagnosis of a tumor (mean, 6.9 years) suggests that the observed increase in risk was not due to the diagnosis of preexisting tumors that resulted in infertility. Also, all but two women in whom ovarian tumors developed were no longer being followed at an infertility clinic at the time of the diagnosis, suggesting that most diagnoses were not the result of increased surveillance during the evaluation for infertility.
The relative risk for the development of borderline tumors was somewhat higher than that for the development of invasive cancer, as compared with the rates in the general population. In addition to a particularly strong etiologic relation, the relatively high risk of borderline ovarian tumors may reflect an increased likelihood of a diagnosis at an early stage in the progression of the tumor (if borderline ovarian tumors progress to invasive tumors) or the diagnosis of some borderline tumors that would otherwise have remained occult in women who had previously received care for infertility.
Interpretation of age-standardized incidence ratios is limited by the possibility that infertile women may differ from the general population with regard to characteristics (such as the pregnancy history) that influence the risk of ovarian tumors. However, the calculated age-standardized incidence ratios were generally consistent with the results of within-cohort analyses, which showed a doubling of the risk associated with ovulatory abnormalities and with the use of clomiphene. The increased risk associated with clomiphene was most evident among women who had used the drug during 12 or more menstrual cycles.
Neither of two previous cohort studies13,14 that assessed the risk of ovarian cancer among infertile women reported a clearly increased risk relative to that expected on the basis of rates in the general population. Although not specifically stated, it is likely that only invasive cancers were considered in these studies. Since in one of the studies13 women were evaluated for infertility between 1935 and 1964, their exposure to clomiphene (which was first approved for use in the United States in the mid-1960s15) or other ovulation-inducing agents was likely to have been minimal.
A series of articles on the results of a combined analysis of 12 U.S. case-control studies reported increased risks of invasive epithelial ovarian cancer,4 borderline epithelial ovarian tumors,5 and nonepithelial ovarian cancer6 associated with the use of fertility drugs. Interpretation of these results is limited by the absence of information about the types of drugs used or the duration of their use. Among gravid women, there was little increased risk of invasive epithelial cancer associated with the use of fertility drugs (relative risk, 1.4; 95 percent confidence interval, 0.5 to 3.6), whereas among nulligravid women, the risk was substantially increased (relative risk, 27.0; 95 percent confidence interval, 2.3 to 315.6)4. In contrast, our results suggest that the risk was elevated among both gravid and nulligravid women. A possible explanation for the differences between these two sets of results is that, in the case-control study, the women who did not become pregnant may have used ovulation-inducing drugs longer than those who conceived.
In the present study, clomiphene was commonly used by infertile women, whether or not they had ovulatory abnormalities. The risk of ovarian tumors associated with long-term use of clomiphene was increased among both the women with ovulatory abnormalities and those with no known ovulatory abnormalities. These results suggest that the increased risk associated with the use of clomiphene is not merely a reflection of the presence of ovarian abnormalities that may be indications for treatment with this drug. Although our findings raise the possibility that prolonged use of clomiphene increases the risk of ovarian tumors, additional, larger studies are needed to test this hypothesis.
Supported in part by a grant (R35 CA-39779) from and a contract (NO1-CN-05230) with the National Cancer Institute.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Cancer Institute.
Source Information
From the Departments of Epidemiology (M.A.R., J.R.D., N.S.W.) and Biostatistics (S.G.S.), School of Public Health and Community Medicine, and the Department of Obstetrics and Gynecology, School of Medicine (D.E.M.), University of Washington; and the Fred Hutchinson Cancer Research Center (M.A.R., J.R.D., N.S.W., S.G.S.) -- all in Seattle.
Address reprint requests to Dr. Rossing at Fred Hutchinson Cancer Research Center, 1124 Columbia St., Seattle, WA 98104.
- References
References
1
Fishel S ,Jackson P . Follicular stimulation for high tech pregnancies: are we playing it safe? BMJ 1989;299:309-311
CrossRef | Web of Science | Medline2
Spirtas R ,Kaufman SC ,Alexander NJ . Fertility drugs and ovarian cancer: red alert or red herring? Fertil Steril 1993;59:291-293
Web of Science | Medline3
Willemsen W ,Kruitwagen R ,Bastiaans B ,Hanselaar T ,Rolland R . Ovarian stimulation and granulosa-cell tumour. Lancet 1993;341:986-988
CrossRef | Web of Science | Medline4
Whittemore AS, Harris R, Itnyre J, Collaborative Ovarian Cancer Group
Web of Science | Medline5
Harris R, Whittemore AS, Itnyre J, Collaborative Ovarian Cancer Group
Web of Science | Medline6
Horn-Ross PL, Whittemore AS, Harris R, Itnyre J, Collaborative Ovarian Cancer Group
CrossRef | Web of Science | Medline7
Richardson GS ,Scully RE ,Nikrui N ,Nelson JH Jr . Common epithelial cancer of the ovary. N Engl J Med 1985;312:415-424
Full Text | Web of Science | Medline8
Wacholder S ,Boivin JF . External comparisons with the case-cohort design. Am J Epidemiol 1987;126:1198-1209
Web of Science | Medline9
Rothman KJ, Boice JD Jr. Epidemiologic analysis with a programmable calculator. New ed. Chestnut Hill, Mass.: Epidemiology Resources, 1982.
10
Breslow NE, Day NE. Statistical methods in cancer research. Vol. 2. The design and analysis of cohort studies. Lyon, France: International Agency for Research on Cancer, 1987. (IARC scientific publications no. 82.)
11
Wacholder S . Practical considerations in choosing between the case-cohort and nested case-control designs. Epidemiology 1991;2:155-158
CrossRef | Medline12
Preston DL, Lubin JH, Pierce DA, McConney ME. EPICURE: risk regression and data analysis software. Seattle: Hirosoft International Corporation, 1993.
13
Brinton LA ,Melton LJ III ,Malkasian GD Jr ,Bond A ,Hoover R . Cancer risk after evaluation for infertility. Am J Epidemiol 1989;129:712-722
Web of Science | Medline14
Ron E ,Lunenfeld B ,Menczer J , et al. Cancer incidence in a cohort of infertile women. Am J Epidemiol 1987;125:780-790
Web of Science | Medline15
Wysowski DK . Use of fertility drugs in the United States, 1973 through 1991. Fertil Steril 1993;60:1096-1098
Web of Science | Medline
- Citing Articles (208)
Citing Articles
1
Sarka Lisonkova, K.S. Joseph. (2012) Temporal trends in clomiphene citrate use: a population-based study. Fertility and Sterility
CrossRef2
Maria Koutsaki, Apostolos Zaravinos, Demetrios A. Spandidos. (2011) Modern Trends into the Epidemiology and Screening of Ovarian Cancer. Genetic Substrate of the Sporadic Form. Pathology & Oncology Research
CrossRef3
F. E. van Leeuwen, H. Klip, T. M. Mooij, A. M. G. van de Swaluw, C. B. Lambalk, M. Kortman, J. S. E. Laven, C. A. M. Jansen, F. M. Helmerhorst, B. J. Cohlen, W. N. P. Willemsen, J. M. J. Smeenk, A. H. M. Simons, F. van der Veen, J. L. H. Evers, P. A. van Dop, N. S. Macklon, C. W. Burger. (2011) Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort. Human Reproduction 26:12, 3456-3465
CrossRef4
Bart C.J.M. Fauser, Basil C. Tarlatzis, Robert W. Rebar, Richard S. Legro, Adam H. Balen, Roger Lobo, Enrico Carmina, Jeffrey Chang, Bulun Yildiz, Joop S.E. Laven, Jacky Boivin, Felice Petraglia, C.N. Wijeyeratne, Robert J. Norman, Andrea Dunaif, Stephen Franks, Robert A. Wild, Daniel Dumesic, Kurt Barnhart. (2011) Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertility and Sterility
CrossRef5
Bulent Duran, Onder Koc, Safak Ozdemirci, Ata Topcuoglu, Ozturk Ozdemir. (2011) In Vivo Evaluation of the Genotoxic Effects of Gonadotropins on Rat Reticulocytes. Current Therapeutic Research 72:2, 60-70
CrossRef6
Neil JOHNSON. (2011) Metformin is a reasonable first-line treatment option for non-obese women with infertility related to anovulatory polycystic ovary syndrome - A meta-analysis of randomised trials. Australian and New Zealand Journal of Obstetrics and Gynaecology 51:2, 125-129
CrossRef7
Jayeon Kim, Kutluk Oktay. (2011) Infertility as a risk factor of ovarian and breast cancer. Expert Review of Obstetrics & Gynecology 6:2, 153-161
CrossRef8
Ronald M. Green. 2011. Ethical Considerations
. , 1117-1130.
CrossRef9
L Lerner-Geva, J Rabinovici, B Lunenfeld. (2010) Ovarian stimulation: is there a long-term risk for ovarian, breast and endometrial cancer?. Women's Health 6:6, 831-839
CrossRef10
Nikos F. Vlahos, Konstantinos P. Economopoulos, George Creatsas. (2010) Fertility drugs and ovarian cancer risk: a critical review of the literature. Annals of the New York Academy of Sciences 1205:1, 214-219
CrossRef11
N. P. Johnson, A. W. Stewart, J. Falkiner, C. M. Farquhar, S. Milsom, V.- P. Singh, Q. L. Okonkwo, K. L. Buckingham, . (2010) PCOSMIC: a multi-centre randomized trial in women with PolyCystic Ovary Syndrome evaluating Metformin for Infertility with Clomiphene. Human Reproduction 25:7, 1675-1683
CrossRef12
Marsha B. Baker, Kristin A. Bendikson. 2010. Induction of Ovulation. , 433-437.
CrossRef13
Joo-Hyun Nam. (2010) Borderline ovarian tumors and fertility. Current Opinion in Obstetrics and Gynecology 22:3, 227-234
CrossRef14
Janelle Luk, Aydin Arici. (2010) Does the ovarian reserve decrease from repeated ovulation stimulations?. Current Opinion in Obstetrics and Gynecology 22:3, 177-182
CrossRef15
T. Cordes, G. Griesinger, K. Diedrich, A. Schultze-Mosgau. (2010) Ovarielle Stimulation. Der Gynäkologe 43:4, 335-340
CrossRef16
Xianjun Liu, Jing Zhang, Jie Yin, Hejun Duan, Yongning Wu, Bing Shao. (2010) Analysis of hormone antagonists in clinical and municipal wastewater by isotopic dilution liquid chromatography tandem mass spectrometry. Analytical and Bioanalytical Chemistry 396:8, 2977-2985
CrossRef17
Nikos F. Vlahos, Konstantinos P. Economopoulos, Stylianos Fotiou. (2010) Endometriosis, in vitro fertilisation and the risk of gynaecological malignancies, including ovarian and breast cancer. Best Practice & Research Clinical Obstetrics & Gynaecology 24:1, 39-50
CrossRef18
Edward Hughes, Julie Brown, John J Collins, Patrick Vanderkerchove, Edward Hughes. 2010. Clomiphene citrate for unexplained subfertility in women. .
CrossRef19
Ivana Rizzuto, Peter Larsen-Disney, Lesley A Smith, Ivana Rizzuto. 2010. Risk of ovarian cancer in women treated with ovarian stimulating drugs for infertility. .
CrossRef20
J. Dauplat, G. Chene, C. Pomel, M.M. Dauplat, G.Le Bouëdec, F. Mishellany, N. Lagarde, Y.J. Bignon, P. Jaffeux, B. Aublet-Cuvelier, P. Dechelotte, J.L. Pouly, F. Penault-Llorca. (2009) Comparison of dysplasia profiles in stimulated ovaries and in those with a genetic risk for ovarian cancer. European Journal of Cancer 45:17, 2977-2983
CrossRef21
Monica R. McLemore, Christine Miaskowski, Bradley E. Aouizerat, Lee-may Chen, Marylin J. Dodd. (2009) Epidemiological and Genetic Factors Associated With Ovarian Cancer. Cancer Nursing 32:4, 281-288
CrossRef22
I dos Santos Silva, P A Wark, V A McCormack, D Mayer, C Overton, V Little, J Nieto, P Hardiman, M Davies, A B MacLean. (2009) Ovulation-stimulation drugs and cancer risks: a long-term follow-up of a British cohort. British Journal of Cancer 100:11, 1824-1831
CrossRef23
Firdevs Bas, Ora Hirsch Pescovitz, Rosemary Steinmetz. (2009) No Activating Mutations of FSH Receptor in Four Children with Ovarian Juvenile Granulosa Cell Tumors and the Association of These Tumors with Central Precocious Puberty. Journal of Pediatric and Adolescent Gynecology 22:3, 173-179
CrossRef24
Karin Sanner, Peter Conner, Kjell Bergfeldt, Paul Dickman, Karin Sundfeldt, Torbjörn Bergh, Kerstin Hagenfeldt, Per Olof Janson, Staffan Nilsson, Ingemar Persson. (2009) Ovarian epithelial neoplasia after hormonal infertility treatment: long-term follow-up of a historical cohort in Sweden. Fertility and Sterility 91:4, 1152-1158
CrossRef25
Thanasak Sueblinvong, Michael E. Carney. (2009) Current Understanding of Risk Factors for Ovarian Cancer. Current Treatment Options in Oncology 10:1-2, 67-81
CrossRef26
Zeynep Ozcan, Husnu Celik, Bilgin Gurates, Hanifi Ibrahim Ozercan, Fethi Hanay, Mehmet Nalbant, Zeynep Dogan. (2009) Effects of ovulation induction agents on ovarian surface epithelium in rats. Reproductive BioMedicine Online 19:3, 314-318
CrossRef27
Artur J. Jakimiuk, Tadeusz Issat. (2009) PCOS and cancer risk. Folia Histochemica et Cytobiologica 47:5, S101-S105
CrossRef28
Nicholas S. Macklon and, Bart C.J.M. Fauser. 2009. Medical Approaches to Ovarian Stimulation for Infertility. , 689-724.
CrossRef29
Robert L. Barbieri. 2009. Female Infertility. , 517-546.
CrossRef30
Françoise Baylis. (2008) Animal Eggs for Stem Cell Research: A Path Not Worth Taking. The American Journal of Bioethics 8:12, 18-32
CrossRef31
R. Calderon-Margalit, Y. Friedlander, R. Yanetz, K. Kleinhaus, M. C. Perrin, O. Manor, S. Harlap, O. Paltiel. (2008) Cancer Risk After Exposure to Treatments for Ovulation Induction. American Journal of Epidemiology 169:3, 365-375
CrossRef32
(2008) Repetitive oocyte donation. Fertility and Sterility 90:5, S194-S195
CrossRef33
G. Chene, F. Penault-Llorca, G. Le Bouedec, F. Mishellany, M.M. Dauplat, P. Jaffeux, B. Aublet-Cuvelier, J.L. Pouly, P. Dechelotte, J. Dauplat. (2008) Ovarian epithelial dysplasia after ovulation induction: time and dose effects. Human Reproduction 24:1, 132-138
CrossRef34
I. Cetin, V. Cozzi, P. Antonazzo. (2008) Infertility as a Cancer Risk Factor – A Review. Placenta 29, 169-177
CrossRef35
Aygul Akyuz, Nesse Sever, Nermsin Gürhan, Murat Dede, Ümit Göktolga. (2008) EFFECT OF DESIRE TO HAVE A BABY ON RISK ACCEPTANCE IN TURKISH INFERTILE WOMEN 1. Psychological Reports 103:2, 577-587
CrossRef36
A. Borini, E. Rebellato. (2008) Focus on Breast and Ovarian Cancer. Placenta 29, 184-190
CrossRef37
Raphaël Hirt, Céline Davy, Juliette Guibert, François Olivennes. (2008) Pregnancy after in vitro fertilization–intracytoplasmic sperm injection obtained with a modified natural cycle in a BRCA1 mutation carrier. Fertility and Sterility 90:4, 1199.e25-1199.e28
CrossRef38
2008. Complications of ovarian stimulation. , 359-378.
CrossRef39
2008. Anovulatory infertility and ovulation induction. , 123-178.
CrossRef40
K.H. Baumann, U. Wagner. (2008) Präventionsstrategien beim Ovarialkarzinom. Der Gynäkologe 41:7, 513-522
CrossRef41
Tony G Zreik, Chakib M Ayoub, Antoine Hannoun, Cynthia J Karam, Adnan R Munkarah. (2008) Fertility drugs and risk of ovarian cancer: dispelling the myth. Current Opinion in Obstetrics and Gynecology 20:3, 313-319
CrossRef42
A. Jensen, H. Sharif, J. H. Olsen, S. K. Kjaer. (2008) Risk of Breast Cancer and Gynecologic Cancers in a Large Population of Nearly 50,000 Infertile Danish Women. American Journal of Epidemiology 168:1, 49-57
CrossRef43
Jared C. Robins, Sandra A. Carson. (2008) Female Fertility: What Every Urologist Must Understand. Urologic Clinics of North America 35:2, 173-181
CrossRef44
Fariba Salehi, Lesley Dunfield, Karen P. Phillips, Daniel Krewski, Barbara C. Vanderhyden. (2008) Risk Factors for Ovarian Cancer: An Overview with Emphasis on Hormonal Factors. Journal of Toxicology and Environmental Health, Part B 11:3-4, 301-321
CrossRef45
I. Juhasz-Böss, C. Lattrich, S. Kerl, R. Görse, O. Ortmann. (2008) Ovarielle Stimulation und Karzinomrisiko. Der Gynäkologe 41:3, 189-193
CrossRef46
AYGUL AKYUZ. (2008) EFFECT OF DESIRE TO HAVE A BABY ON RISK ACCEPTANCE IN TURKISH INFERTILE WOMEN. Psychological Reports 103:6, 577
CrossRef47
Christine Vo, Michael E. Carney. (2007) Ovarian Cancer Hormonal and Environmental Risk Effect. Obstetrics and Gynecology Clinics of North America 34:4, 687-700
CrossRef48
T. Cordes, A. Schultze-Mosgau, G. Griesinger, K. Diedrich, S. Otte. (2007) Krebsrisiko nach ovarieller Simulation. Gynäkologische Endokrinologie 5:4, 198-202
CrossRef49
A. Schröer, M. Wolf, G. Griesinger, M.K. Bohlmann, T. Strowitzki, K. Diedrich. (2007) Gefahren und Risiken der Reproduktionsmedizin. Gynäkologische Endokrinologie 5:4, 193-197
CrossRef50
CAROLYN MCLEOD, FRANÇOISE BAYLIS. (2007) DONATING FRESH VERSUS FROZEN EMBRYOS TO STEM CELL RESEARCH: IN WHOSE INTERESTS?. Bioethics 21:9, 465-477
CrossRef51
G. Griesinger, K. Diedrich. (2007) Risiken der ovariellen Stimulation zur IVF. Der Gynäkologe 40:10, 773-779
CrossRef52
Mita Giacomini, Francoise Baylis, Jason Robert. (2007) Banking on it: Public policy and the ethics of stem cell research and development. Social Science & Medicine 65:7, 1490-1500
CrossRef53
Giovanni D. Aletti, Mary M. Gallenberg, William A. Cliby, Aminah Jatoi, Lynn C. Hartmann. (2007) Current Management Strategies for Ovarian Cancer. Mayo Clinic Proceedings 82:6, 751-770
CrossRef54
G. D. Aletti, M. M. Gallenberg, W. A. Cliby, A. Jatoi, L. C. Hartmann. (2007) Current Management Strategies for Ovarian Cancer. Mayo Clinic Proceedings 82:6, 751-770
CrossRef55
Masaki Mandai, Ikuo Konishi, Hideki Kuroda, Shingo Fujii. (2007) LH/hCG action and development of ovarian cancer—A short review on biological and clinical/epidemiological aspects. Molecular and Cellular Endocrinology 269:1-2, 61-64
CrossRef56
A J Swerdlow, M E Jones. (2007) Ovarian cancer risk in premenopausal and perimenopausal women treated with Tamoxifen: a case–control study. British Journal of Cancer 96:5, 850-855
CrossRef57
Anne Fortin, Philippe Morice, Anne Thoury, Sophie Camatte, Caroline Dhainaut, Patrick Madelenat. (2007) Impact of infertility drugs after treatment of borderline ovarian tumors: results of a retrospective multicenter study. Fertility and Sterility 87:3, 591-596
CrossRef58
Louise Brinton. (2007) Long-term effects of ovulation-stimulating drugs on cancer risk. Reproductive BioMedicine Online 15:1, 38-44
CrossRef59
Shokichi Teramoto, Osamu Kato. (2007) Minimal ovarian stimulation with clomiphene citrate: a large-scale retrospective study. Reproductive BioMedicine Online 15:2, 134-148
CrossRef60
Chan Woo Park, Kwang Moon Yang, Hye Ok Kim, Sung Ran Hong, Tae Jin Kim, Kyung Taek Lim, Ki Heon Lee, Inn Soo Kang. (2007) Outcomes of Controlled Ovarian Hyperstimulation/In Vitro Fertilization for Infertile Patients with Borderline Ovarian Tumor after Conservative Treatment. Journal of Korean Medical Science 22:Suppl, S134
CrossRef61
C.-Y. YANG, H.-W. KUO, H.-F. CHIU. (2007) Age at first birth, parity, and risk of death from ovarian cancer in Taiwan: a country of low incidence of ovarian cancer. International Journal of Gynecological Cancer 17:1, 32-36
CrossRef62
Mohamed FM Mitwally, Robert F Casper. (2006) Letrozole for ovulation induction. Expert Review of Obstetrics & Gynecology 1:1, 15-27
CrossRef63
Neeraja B. Peterson, Amy Trentham-Dietz, Polly A. Newcomb, Zhi Chen, Tebeb Gebretsadik, John M. Hampton, Meir J. Stampfer, Walter C. Willett, Kathleen M. Egan. (2006) Relation of Anthropometric Measurements to Ovarian Cancer Risk in a Population-based Case–control Study (United States). Cancer Causes & Control 17:4, 459-467
CrossRef64
Ali Mahdavi, Tanja Pejovic, Farr Nezhat. (2006) Induction of ovulation and ovarian cancer: a critical review of the literature. Fertility and Sterility 85:4, 819-826
CrossRef65
Jean S. Fleming, Clare R. Beaugié, Izhak Haviv, Georgia Chenevix-Trench, Olivia L. Tan. (2006) Incessant ovulation, inflammation and epithelial ovarian carcinogenesis: Revisiting old hypotheses. Molecular and Cellular Endocrinology 247:1-2, 4-21
CrossRef66
Joseph C Gambone. (2006) Are Adverse Pregnancy and Fetal Outcomes More Common With Assisted Reproductive Technologies? What Should Patients Be Told?. Clinical Obstetrics and Gynecology 49:1, 123-133
CrossRef67
S. Z. Bu, Q. Huang, Y. M. Jiang, H. B. Min, Y. Hou, Z. Y. Guo, J. F. Wei, J. W. Wang, X. Ni, S. S. Zheng. (2006) p38 Mitogen-activated protein kinases is required for counteraction of 2-methoxyestradiol to estradiol-stimulated cell proliferation and induction of apoptosis in ovarian carcinoma cells via phosphorylation Bcl-2. Apoptosis 11:3, 413-425
CrossRef68
Shin-Yee Ling, Kian-Mei Chong, Jiann-Loung Hwang. (2006) Persistent Megalocystic Ovary Following in Vitro Fertilization in a Postpartum Patient with Polycystic Ovarian Syndrome. Taiwanese Journal of Obstetrics and Gynecology 45:1, 70-72
CrossRef69
Bulent Duran, Ismail Ozdemir, Yeltekin Demirel, Ozturk Ozdemir, Ali Cetin, Aysel Guven. (2006) In vivo Evaluation of the Genotoxic Effects of Clomiphene Citrate on Rat Reticulocytes: A Micronucleus Genotoxicity. Gynecologic and Obstetric Investigation 61:4, 228-231
CrossRef70
2006. Gonadotropins. , 1536-1541.
CrossRef71
I. KONISHI. (2006) Gonadotropins and ovarian carcinogenesis: a new era of basic research and its clinical implications. International Journal of Gynecological Cancer 16:1, 16-22
CrossRef72
Diane Beeson, Abby Lippman. (2006) Egg harvesting for stem cell research: medical risks and ethical problems. Reproductive BioMedicine Online 13:4, 573-579
CrossRef73
A. CORAKCI, S. FILIZ, E. CALISKAN, C. DALCIK, S. OZEREN, H. DALCIK. (2005) The effects of ovulation induction on ovarian epithelium dysplasia scores and Ki67 expression: an experimental study on rats. International Journal of Gynecological Cancer 15:5, 866-871
CrossRef74
Semih Kaleli, Gulderen Yanikkaya-Demirel, C. Tamer Erel, Levent M. Senturk, Ata Topçuoğlu, Tulay Irez. (2005) High rate of aneuploidy in luteinized granulosa cells obtained from follicular fluid in women who underwent controlled ovarian hyperstimulation. Fertility and Sterility 84:3, 802-804
CrossRef75
Louise A. Brinton, Carolyn L. Westhoff, Bert Scoccia, Emmet J. Lamb, Michelle D. Althuis, Jerome E. Mabie, Kamran S. Moghissi. (2005) Causes of Infertility as Predictors of Subsequent Cancer Risk. Epidemiology 16:4, 500-507
CrossRef76
Shondell M. Bouie, Bernadette Cracchiolo, Debra Heller. (2005) Epithelioid leiomyosarcoma of the ovary. Gynecologic Oncology 97:2, 697-699
CrossRef77
Freddie Bray, Anja Helena Loos, Sandro Tognazzo, Carlo La Vecchia. (2005) Ovarian cancer in Europe: Cross-sectional trends in incidence and mortality in 28 countries, 1953-2000. International Journal of Cancer 113:6, 977-990
CrossRef78
Louise A. Brinton, Kamran S. Moghissi, Bert Scoccia, Carolyn L. Westhoff, Emmet J. Lamb. (2005) Ovulation induction and cancer risk. Fertility and Sterility 83:2, 261-274
CrossRef79
Katherine D. Crew, Michael H. Cohen, Daniel H. Smith, Amy D. Tiersten, Nikki M. Feirt, Dawn L. Hershman. (2005) Long natural history of recurrent granulosa cell tumor of the ovary 23 years after initial diagnosis: a case report and review of the literature. Gynecologic Oncology 96:1, 235-240
CrossRef80
Luca Dal Prato, Andrea Borini, Monica Cattoli, Maria Serena Preti, Lucia Serrao, Carlo Flamigni. (2005) Live birth after IVF in a 46-year-old woman. Reproductive BioMedicine Online 11:4, 452-454
CrossRef81
Talha Al-Shawaf, Ariel Zosmer, Martha Dirnfeld, Gedis Grudzinskas. (2005) Safety of Drugs Used in Assisted Reproduction Techniques. Drug Safety 28:6, 513-528
CrossRef82
Ismail Ozdemir, Nil Ustundag, Aysel Guven, Bulent Duran, Fuat Demirci. (2005) Effect of Clomiphene Citrate on Ovarian, Endometrial, and Cervical Histologies in a Rat Model. Gynecologic and Obstetric Investigation 60:4, 181-185
CrossRef83
Christoph Dorn, Hans van der Ven. (2005) Clomiphene citrate versus gonadotrophins for ovulation stimulation. Reproductive BioMedicine Online 10, 37-43
CrossRef84
Cannistra, Stephen A., . (2004) Cancer of the Ovary. New England Journal of Medicine 351:24, 2519-2529
Full Text85
Ali Ayhan, Mehmet Coskun Salman, Husnu Celik, Polat Dursun, Ozgur Ozyuncu, Murat Gultekin. (2004) Association between fertility drugs and gynecologic cancers, breast cancer, and childhood cancers. Acta Obstetricia et Gynecologica Scandinavica 83:12, 1104-1111
CrossRef86
Sozos J. Fasouliotis, Owen Davis, Glenn Schattman, Steven D. Spandorfer, Isaac Kligman, Zev Rosenwaks. (2004) Safety and efficacy of infertility treatment after conservative management of borderline ovarian tumors: A preliminary report. Fertility and Sterility 82:3, 568-572
CrossRef87
(2004) Effectiveness and treatment for unexplained infertility. Fertility and Sterility 82, 160-163
CrossRef88
(2004) Repetitive oocyte donation. Fertility and Sterility 82, 158-159
CrossRef89
Tomas Riman, Staffan Nilsson, Ingemar R. Persson. (2004) Review of epidemiological evidence for reproductive and hormonal factors in relation to the risk of epithelial ovarian malignancies. Acta Obstetricia et Gynecologica Scandinavica 83:9, 783-795
CrossRef90
(2004) Use of clomiphene citrate in women. Fertility and Sterility 82, 90-96
CrossRef91
Louise A Brinton, Emmet J Lamb, Kamran S Moghissi, Bert Scoccia, Michelle D Althuis, Jerome E Mabie, Carolyn L Westhoff. (2004) Ovarian cancer risk associated with varying causes of infertility. Fertility and Sterility 82:2, 405-414
CrossRef92
C. Celik, K. GezginC, M. Aktan, A. Acar, S. T. Yaman, S. Gungor, C. Akyurek. (2004) Effects of ovulation induction on ovarian morphology: an animal study. International Journal of Gynecological Cancer 14:4, 600-606
CrossRef93
Louise A. Brinton, Emmet J. Lamb, Kamran S. Moghissi, Bert Scoccia, Michelle D. Althuis, Jerome E. Mabie, Carolyn L. Westhoff. (2004) Ovarian Cancer Risk After the Use of Ovulation-Stimulating Drugs. Obstetrics & Gynecology 103:6, 1194-1203
CrossRef94
Mark Avdalovic, Andrew Chan. (2004) Thoracic manifestations of common nonpulmonary malignancies of women. Clinics in Chest Medicine 25:2, 379-390
CrossRef95
Elżbieta Senkus-Konefka, Tomasz Konefka, Jacek Jassem. (2004) The effects of tamoxifen on the female genital tract. Cancer Treatment Reviews 30:3, 291-301
CrossRef96
Christer Borgfeldt, Ellika Andolf. (2004) Cancer risk after hospital discharge diagnosis of benign ovarian cysts and endometriosis. Acta Obstetricia et Gynecologica Scandinavica 83:4, 395-400
CrossRef97
Sonya Kashyap, David Moher, Michael Fung Kee Fung, Zev Rosenwaks. (2004) Assisted Reproductive Technology and the Incidence of Ovarian Cancer: A Meta-Analysis. Obstetrics & Gynecology 103:4, 785-794
CrossRef98
Raffi Chalian, Fred Licciardi, Andrei Rebarber, Giuseppe Del Priore. (2004) Successful Infertility Treatment in a Cancer Patient with a Significant Personal and Family History of Cancer. Journal of Women's Health 13:2, 235-237
CrossRef99
Alka Prakash, Tin-Chiu Li, William L. Ledger. (2004) The management of ovarian cysts in premenopausal women. The Obstetrician & Gynaecologist 6:1, 12-15
CrossRef100
Therese L. Luce, Karen Hassey Dow, Lygia Holcomb. (2003) Early Diagnosis Key to Epithelial Ovarian Cancer Detection. The Nurse Practitioner 28:12, 41-47
CrossRef101
Michael P Steinkampf, Sejal P Dharia, Karen Hammond. (2003) Assisted reproduction in patients with early-stage ovarian malignancies. Fertility and Sterility 80:6, 1510-1512
CrossRef102
Klaus Fiedler, Michael Ludwig. (2003) Use of clomiphene citrate in in vitro fertilization (IVF) and IVF/intracytoplasmic sperm injection cycles. Fertility and Sterility 80:6, 1521-1523
CrossRef103
(2003) CYP1A1 polymorphism and risk of gynecological malignancy in Japan. International Journal of Gynecological Cancer 13:6, 785-790
CrossRef104
(2003) Use of clomiphene citrate in women. Fertility and Sterility 80:5, 1302-1308
CrossRef105
Francesmary Modugno. (2003) Ovarian cancer and high-risk women—implications for prevention, screening, and early detection. Gynecologic Oncology 91:1, 15-31
CrossRef106
Simon M. Kelly, William M. Buckett, Seang Lin Tan. (2003) Effect of repeated assisted reproductive technology on ovarian response. Current Opinion in Obstetrics and Gynecology 15:3, 219-224
CrossRef107
Annika Riska, Arto Leminen, Eero Pukkala. (2003) Sociodemographic determinants of incidence of primary fallopian tube carcinoma, Finland 1953-97. International Journal of Cancer 104:5, 643-645
CrossRef108
A WATRELOT. (2003) Advances in the assessment of the uterus and fallopian tube function. Best Practice & Research Clinical Obstetrics & Gynaecology 17:2, 187-209
CrossRef109
A VENN. (2003) Cancer risks associated with the diagnosis of infertility. Best Practice & Research Clinical Obstetrics & Gynaecology 17:2, 343-367
CrossRef110
Peter Y.K Yong, Sandra Brett, David T Baird, K.J Thong. (2003) A prospective randomized clinical trial comparing 150 IU and 225 IU of recombinant follicle-stimulating hormone (Gonal-F*) in a fixed-dose regimen for controlled ovarian stimulation in in vitro fertilization treatment. Fertility and Sterility 79:2, 308-315
CrossRef111
Robert F. Ozols, Mary B. Daly, Andres Klein-Szanto, Thomas C. Hamilton, Robert C. Bast, Molly A. Brewer. (2003) Specific Keynote: Chemoprevention of Ovarian Cancer: The Journey Begins. Gynecologic Oncology 88:1, S59-S66
CrossRef112
l. lerner-geva, e. geva, j.b. lessing, a. chetrit, b. modan, a. amit. (2003) The possible association between in vitro fertilization treatments and cancer development. International Journal of Gynecological Cancer 13:1, 23-27
CrossRef113
David E Tourgeman, Jean J Lu, Robert Boostanfar, Charles Amezcua, Juan C Felix, Richard J Paulson. (2002) Human chorionic gonadotropin suppresses ovarian epithelial neoplastic cell proliferation in vitro. Fertility and Sterility 78:5, 1096-1099
CrossRef114
Richard P Dickey, Steven N Taylor, Peter Y Lu, Belinda M Sartor, Phillip H Rye, Roman Pyrzak. (2002) Effect of diagnosis, age, sperm quality, and number of preovulatory follicles on the outcome of multiple cycles of clomiphene citrate-intrauterine insemination. Fertility and Sterility 78:5, 1088-1095
CrossRef115
Ronald Green. 2002. Human Subjects Research, Ethics, Research on Human Embryos. .
CrossRef116
Joanne McManus, Neil McClure. (2002) Complications of assisted reproduction. The Obstetrician & Gynaecologist 4:3, 124-129
CrossRef117
N. D. C. Sturrock, B. Lannon, T. N. Fay. (2002) Metformin does not enhance ovulation induction in clomiphene resistant polycystic ovary syndrome in clinical practice. British Journal of Clinical Pharmacology 53:5, 469-473
CrossRef118
Peter J. Fuller, Simon Chu, Sonay Fikret, Henry G. Burger. (2002) Molecular pathogenesis of granulosa cell tumours. Molecular and Cellular Endocrinology 191:1, 89-96
CrossRef119
Abraham Benshushan, Amnon Brzezinski. (2002) Hormonal Manipulations and Breast Cancer. Obstetrical and Gynecological Survey 57:5, 314-323
CrossRef120
Jehoshua Dor, Liat Lerner-Geva, Jaron Rabinovici, Angela Chetrit, David Levran, Bruno Lunenfeld, Shlomo Mashiach, Baruch Modan. (2002) Cancer incidence in a cohort of infertile women who underwent in vitro fertilization. Fertility and Sterility 77:2, 324-327
CrossRef121
Hugo Sovino, Teresa Sir-Petermann, Luigi Devoto. (2002) Clomiphene citrate and ovulation induction. Reproductive BioMedicine Online 4:3, 303-310
CrossRef122
R. J. Edmondson, J. M. Monaghan. (2001) The epidemiology of ovarian cancer. International Journal of Gynecological Cancer 11:6, 423-429
CrossRef123
Vincent Argent, Zoe Woodward. (2001) Consent and the ovary. The Obstetrician & Gynaecologist 3:4, 206-210
CrossRef124
GIUSEPPE PRIORE, J. RICHARD SMITH, DEBORAH C.M. BOYLE, DAVID J. CORLESS, FARIS B.P. ZACHARIA, DAVID A. NOAKES, THOMAS DIFLO, JAMES A. GRIFO, JOHN J. ZHANG. (2001) Uterine Transplantation, Abdominal Trachelectomy, and Other Reproductive Options for Cancer Patients. Annals of the New York Academy of Sciences 943:1, 287-295
CrossRef125
Jose J. Nieto, Julie Crow, Maryse Sundaresan, Niculae Constantinovici, Christopher W. Perrett, Allan B. MacLean, Paul J. Hardiman. (2001) Ovarian Epithelial Dysplasia in Relation to Ovulation Induction and Nulliparity. Gynecologic Oncology 82:2, 344-349
CrossRef126
Mario E. Beiner, Walter H. Gotlieb, Ben Davidson, Juri Kopolovic, Gilad Ben-Baruch. (2001) Infertility treatment after conservative management of borderline ovarian tumors. Cancer 92:2, 320-325
CrossRef127
Alison Venn, Penelope Jones, Michael Quinn, David Healy. (2001) Characteristics of Ovarian and Uterine Cancers in a Cohort of in Vitro Fertilization Patients. Gynecologic Oncology 82:1, 64-68
CrossRef128
C La Vecchia. (2001) Epidemiology of ovarian cancer: a summary review. European Journal of Cancer Prevention 10:2, 125-129
CrossRef129
W PHIPPS. (2001) Polycystic Ovary Syndrome And Ovulation Induction. Obstetrics and Gynecology Clinics of North America 28:1, 165-182
CrossRef130
V. Sivanesaratnam. (2001) Fertility and Gynaecologic Malignancies. Journal of Obstetrics and Gynaecology Research 27:1, 1-15
CrossRef131
Jeff A Parrott, Vinayak Doraiswamy, Grace Kim, Rachel Mosher, Michael K Skinner. (2001) Expression and actions of both the follicle stimulating hormone receptor and the luteinizing hormone receptor in normal ovarian surface epithelium and ovarian cancer. Molecular and Cellular Endocrinology 172:1-2, 213-222
CrossRef132
Gamal H Eltabbakh, Christopher S Awtrey. (2001) Current treatment for ovarian cancer. Expert Opinion on Pharmacotherapy 2:1, 109-124
CrossRef133
T.-Y. Lee, S.-C. Chao, G.-H Sun. (2001) THE EFFECT OF AN INFERTILITY DIAGNOSIS ON TREATMENT-RELATED STRESSES. Systems Biology in Reproductive Medicine 46:1, 67-71
CrossRef134
Souzan Nasseri, William Leigh Ledger. (2001) Clomiphene citrate in the twenty-first century. Human Fertility 4:3, 145-151
CrossRef135
Leila Unkila-Kallio, Aila Tiitinen, Henrik Alfthan, Piia Vuorela, Ulf-Håkan Stenman, Olavi Ylikorkala. (2000) Effect of an in vitro fertilization program on serum CA 125, tumor-associated trypsin inhibitor, free β-subunit of human chorionic gonadotropin, and common α-subunit of glycoprotein hormones. Fertility and Sterility 74:6, 1125-1132
CrossRef136
LYNDA J. WOLF. (2000) Ovulation Induction. Clinical Obstetrics and Gynecology 43:4, 902-915
CrossRef137
Jean J. Lu, Yu Zheng, Xin Kang, Jian-Min Yuan, Stuart C. Lauchlan, Malcolm C. Pike, Wenxin Zheng. (2000) Decreased Luteinizing Hormone Receptor mRNA Expression in Human Ovarian Epithelial Cancer. Gynecologic Oncology 79:2, 158-168
CrossRef138
M.M. Reinholz, M.A. Zschunke, P.C. Roche. (2000) Loss of Alternately Spliced Messenger RNA of the Luteinizing Hormone Receptor and Stability of the Follicle-Stimulating Hormone Receptor Messenger RNA in Granulosa Cell Tumors of the Human Ovary. Gynecologic Oncology 79:2, 264-271
CrossRef139
Ingemar Persson. (2000) Estrogens in the causation of breast, endometrial and ovarian cancers — evidence and hypotheses from epidemiological findings. The Journal of Steroid Biochemistry and Molecular Biology 74:5, 357-364
CrossRef140
Dongmei Zhang, William F. Holmes, Shujian Wu, Dianne R. Soprano, Kenneth J. Soprano. (2000) Retinoids and ovarian cancer. Journal of Cellular Physiology 185:1, 1-20
CrossRef141
Adeola Olaitan, Amanda Mocroft, Ian Jacobs. (2000) Patterns in the incidence of age-related ovarian cancer in South East England 1967-1996. BJOG: An International Journal of Obstetrics and Gynaecology 107:9, 1094-1096
CrossRef142
Asher Shushan, Neri Laufer. (2000) Fertility drugs and ovarian cancer: what are the practical implications of the ongoing debate?. Fertility and Sterility 74:1, 8-9
CrossRef143
Christine H. Holschneider, Jonathan S. Berek. (2000) Ovarian cancer: Epidemiology, biology, and prognostic factors. Seminars in Surgical Oncology 19:1, 3-10
CrossRef144
Liat Lerner-Geva, Amos Toren, Angela Chetrit, Baruch Modan, Mathilda Mandel, Gideon Rechavi, Jehoshuah Dor. (2000) The risk for cancer among children of women who underwent in vitro fertilization. Cancer 88:12, 2845-2847
CrossRef145
Maureen Moomjy, Robin Mangieri, Fernando Beltramone, Ina Cholst, Lucinda Veeck, Zev Rosenwaks. (2000) Shared oocyte donation: society’s benefits. Fertility and Sterility 73:6, 1165-1169
CrossRef146
C. W. Burger, H. M. Prinssen, J. P. A. Baak, N. Wagenaar, P. Kenemans. (2000) The management of borderline epithelial tumors of the ovary. International Journal of Gynecological Cancer 10:3, 181-197
CrossRef147
Deborah Leibowitz, Janet Hoffman. (2000) Fertility Drug Therapies: Past, Present, and Future. Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing 29:2, 201-210
CrossRef148
Katie E Wakeley, Edward C Grendys. (2000) Reproductive technologies and risk of ovarian cancer. Current Opinion in Obstetrics and Gynecology 12:1, 43-47
CrossRef149
Diane Bodurka-Bevers, Charlotte C. Sun, David M. Gershenson. (2000) Pharmacoeconomic Considerations in Treating Ovarian Cancer. PharmacoEconomics 17:2, 133-150
CrossRef150
Edward Hughes, Julie Brown, John J Collins, Patrick Vanderkerchove, Edward Hughes. 2000. Clomiphene citrate for unexplained subfertility in women. .
CrossRef151
Paul Hardiman, Jose J. Nieto, Allan B. MacLean. (2000) Infertility and Ovarian Cancer. Gynecologic Oncology 76:1, 1-2
CrossRef152
Mary Anne Rossing, Janet R Daling. (1999) Complexity of surveillance for cancer risk associated with in-vitro fertilisation. The Lancet 354:9190, 1573-1574
CrossRef153
Alison Venn, Lyndsey Watson, Fiona Bruinsma, Graham Giles, David Healy. (1999) Risk of cancer after use of fertility drugs with in-vitro fertilisation. The Lancet 354:9190, 1586-1590
CrossRef154
Jonathan M Lord, Umesh Acharya. (1999) The treatment of ovulatory disorders. The Obstetrician & Gynaecologist 1:2, 33-35
CrossRef155
Elaine Ron, Anssi Auvinen, Esther Alfandary, Marilyn Stovall, Baruch Modan, Avraham Werner. (1999) Cancer risk following radiotherapy for infertility or menstrual disorders. International Journal of Cancer 82:6, 795-798
CrossRef156
R. B. Ness, C. Cottreau. (1999) Possible Role of Ovarian Epithelial Inflammation in Ovarian Cancer. JNCI Journal of the National Cancer Institute 91:17, 1459-1467
CrossRef157
JJ Nieto, KJ Rolfe, AB MacLean, P Hardiman. (1999) Ovarian cancer and infertility: a genetic link?. The Lancet 354:9179, 649
CrossRef158
Amanda Evans, Beverley Vollenhoven, David Healy. (1999) Modern Antioestrogens and the Coming Revolution in Women's Health Care. The Australian and New Zealand Journal of Obstetrics and Gynaecology 39:3, 334-340
CrossRef159
A Shushan. (1999) Induction of ovulation and borderline ovarian cancer — the hormonal connection?. European Journal of Obstetrics & Gynecology and Reproductive Biology 85:1, 71-74
CrossRef160
Cynthia F. Robinson, James T. Walker. (1999) Cancer mortality among women employed in fast-growing U.S. occupations. American Journal of Industrial Medicine 36:1, 186-192
CrossRef161
Linda R. Duska, YuChiao Chang, Cynthia E. Flynn, Annette H. Chen, Annekathryn Goodman, Arlan F. Fuller, Najmosama Nikrui. (1999) Epithelial ovarian carcinoma in the reproductive age group. Cancer 85:12, 2623-2629
CrossRef162
Meagan M. Moore, Krishnansu Tewari, G.Scott Rose, John P. Fruehauf, Philip J. DiSaia. (1999) Long-Term Consequences Following Conservative Management of Epithelial Ovarian Cancer in an Infertile Patient. Gynecologic Oncology 73:3, 452-454
CrossRef163
T. Scott Jennings, Mary E. Haddad, Timothy M. Smith. (1999) Clear Cell Ovarian Carcinoma Following Long-Term Tamoxifen Use. The Breast Journal 5:2, 132-135
CrossRef164
Günter Emons, John J. Kavanagh. (1999) HORMONAL INTERACTIONS IN OVARIAN CANCER. Hematology/Oncology Clinics of North America 13:1, 145-161
CrossRef165
R. J. Norman, E. McVeigh. (1999) Polcystic ovary syndrome and implications for the menopause. Climacteric 2:2, 141-143
CrossRef166
Andrew M Kaunitz. (1999) Oral contraceptive health benefits: perception versus reality. Contraception 59:1, 29S-33S
CrossRef167
Andrea Kraft, Karin Weindel, Andreas Ochs, Christian Marth, J
rg Zmija, Petra Schumacher, Clemens Unger, Dieter Marm
CrossRef168
Ran Goshen, Ariel Weissman, Zeev Shoham. (1998) 5 Epithelial ovarian cancer, infertility and induction of ovulation: possible pathogenesis and updated concepts. Baillière's Clinical Obstetrics and Gynaecology 12:4, 581-591
CrossRef169
Tomas Riman, Ingemar Persson, Staffan Nilsson. (1998) Hormonal aspects of epithelial ovarian cancer: review of epidemiological evidence. Clinical Endocrinology 49:6, 695-707
CrossRef170
Berit Jul Mosgaard, Øjvind Lidegaard, Susanne Krüger Kjær, Geert Schou, Anders Nyboe Andersen. (1998) Ovarian stimulation and borderline ovarian tumors: a case-control study. Fertility and Sterility 70:6, 1049-1055
CrossRef171
Adam Balen. (1998) 1 Endocrine methods of ovulation induction. Baillière's Clinical Obstetrics and Gynaecology 12:4, 521-539
CrossRef172
Juha S Tapanainen, Tommi Vaskivuo, Kristiina Aittomäki, Ilpo T Huhtaniemi. (1998) Inactivating FSH receptor mutations and gonadal dysfunction. Molecular and Cellular Endocrinology 145:1-2, 129-135
CrossRef173
Kirsten Duckitt, Allan A. Templeton. (1998) Cancer in women with infertility. Current Opinion in Obstetrics and Gynaecology 10:3, 199-203
CrossRef174
D. Nugent, O. Salha, A. H. Balen, A. J. Rutherford. (1998) Ovarian neoplasia and subfertility treatments. BJOG: An International Journal of Obstetrics and Gynaecology 105:6, 584-591
CrossRef175
T. C. Li, H. Saravelos, M. S. Chow, R. Chisabingo, I. D. Cooke. (1998) Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility. BJOG: An International Journal of Obstetrics and Gynaecology 105:3, 338-344
CrossRef176
Daniel V. Surbek, Irene Hoesli, Joachim Torhorst, Alfonso C. Almendral, Athanassios Dellas, Wolfgang Holzgreve. (1998) Virilizing Ovarian Tumor of Low Malignant Potential Associated with Antecedent Tamoxifen Use for Breast Cancer. Gynecologic Oncology 68:3, 293-296
CrossRef177
LEE-MAY CHEN, BETH Y. KARLAN. (1998) Early Detection and Risk Reduction for Familial Gynecologic Cancers. Clinical Obstetrics and Gynecology 41:1, 200-214
CrossRef178
Fabio Parazzini, Eva Negri, Carlo La Vecchia, Simona Moroni, Anna Polatti, Francesca Chiaffarino, Matteo Surace, Elena Ricci. (1998) Treatment for Fertility and Risk of Ovarian Tumors of Borderline Malignancy. Gynecologic Oncology 68:3, 226-228
CrossRef179
Krishnansu Tewari, G Scott Rose, Keith D Balderston, Manuel Porto, Matthew F Kohler. (1998) Fertility drugs and malignant germ-cell tumour of ovary in pregnancy. The Lancet 351:9107, 957-958
CrossRef180
Walter H. Gotlieb, Sharon Flikker, Ben Davidson, Yaacov Korach, Juri Kopolovic, Gilad Ben-Baruch. (1998) Borderline tumors of the ovary. Cancer 82:1, 141-146
CrossRef181
José Iscovich, Asher Shushan, Joseph G. Schenker, Ora Paltiel. (1998) The incidence of borderline ovarian tumors in israel. Cancer 82:1, 147-151
CrossRef182
AJ Venn, DL Healy. (1997) Fertility drugs and cancer. Reproductive Medicine Review 6:03, 185
CrossRef183
Barry Rosen, Jane Irvine, Paul Ritvo, Heather Shapiro, Donna Stewart, Karina Reynolds, Gail Robinson, Jackie Thomas, Jan Neuman, Joan Murphy. (1997) The feasibility of assessing women's perceptions of the risks and benefits of fertility drug therapy in relation to ovarian cancer risk. Fertility and Sterility 68:1, 90-94
CrossRef184
Berit Jul Mosgaard, Øjvind Lidegaard, Susanne Krüger Kjaer, Geert Schou, Anders Nyboe Andersen. (1997) Infertility, fertility drugs, and invasive ovarian cancer: a case-control study. Fertility and Sterility 67:6, 1005-1012
CrossRef185
V. DRAMUSIC, U. RAJAN, P. CHAN, S. S. RATNAM, Y. C. WONG. (1997) Adolescent Polycystic Ovary Syndrome. Annals of the New York Academy of Sciences 816:1 Adolescent Gy, 194-208
CrossRef186
Edward C. Ditkoff, Tyrone Tucker, Richard U. Levine, Steven R. Lindheim, Mark V. Sauer, Teri Longacre. (1997) Bilateral serous cystadenofibromas clinically simulating hyperreactio luteinalis following controlled ovarian hyperstimulation and in vitro fertilization. Journal of Assisted Reproduction and Genetics 14:4, 230-233
CrossRef187
Antonella Surbone, Jeanne A. Petrek. (1997) Childbearing issues in breast carcinoma survivors. Cancer 79:7, 1271-1278
CrossRef188
Richard J. Paulson. (1997) Fertility drugs and ovarian epithelial cancer: The endometriosis hypothesis. Journal of Assisted Reproduction and Genetics 14:4, 228-230
CrossRef189
Louise A. Brinton, Gloria Gridley, Ingemar Persson, John Baron, Agneta Bergqvist. (1997) Cancer risk after a hospital discharge diagnosis of endometriosis. American Journal of Obstetrics and Gynecology 176:3, 572-579
CrossRef190
J. Menczer, Livia Theodor, Eitan Friedman. (1997) BRCA1 185delAG mutation in a non-Ashkenazi Jewish woman with early-onset breast and ovarian cancer. American Journal of Obstetrics and Gynecology 176:3, 731
CrossRef191
Gail M. Clinton, Wenhui Hua. (1997) Estrogen action in human ovarian cancer. Critical Reviews in Oncology/Hematology 25:1, 1-9
CrossRef192
Richard J. Paulson. (1996) Fertility drugs and ovarian epithelial cancer: Is there a link?. Journal of Assisted Reproduction and Genetics 13:10, 751-756
CrossRef193
Lorne J. Brandes, Mary Cheang. (1996) Brandes and Cheang Reply to Comments on Fluoxetine in Carcinogenicity. Journal of Clinical Psychopharmacology 16:4, 337-339
CrossRef194
Bradford Alan Kolb, Richard J Paulson. (1996) Unstimulated in vitro fertilization revisited. Reproductive Medicine Review 5:02, 129
CrossRef195
Edward Hughes, John Collins, Patrick Vandekerckhove, Edward Hughes. 1996. Clomiphene citrate for ovulation induction in women with oligo-amenorrhoea. .
CrossRef196
(1996) Early ovarian cancer: A review of its genetic and biologic factors, detection, and treatment. Current Problems in Cancer 20:2, 86-137
CrossRef197
Valerie L. Baker, Robert B. Jaffe. (1996) Clinical Uses of Antiestrogens. Obstetrical & Gynecological Survey 51:1, 45-59
CrossRef198
M. Rajkhowa, R.N. Clayton. (1995) Polycystic ovary syndrome. Current Obstetrics & Gynaecology 5:4, 191-200
CrossRef199
Mary Anne Rossing, NoelS. Weiss, Carlo La Vecchia, Eva Negri, Fabio Parazzini, Silvia Franceschi. (1995) Fertility drugs and breast and ovarian cancer. The Lancet 346:8990, 1627-1628
CrossRef200
Elizabeth B. Claus, Peter E. Schwartz. (1995) Familial ovarian cancer. Update and clinical applications. Cancer 76:S10, 1998-2003
CrossRef201
Robert F Casper, Selim Senoz, Avraham Ben-Chetrit. (1995) The use of oral contraceptives in women over age 35 years. Reproductive Medicine Review 4:02, 115
CrossRef202
STEVEN C. KAUFMAN, ROBERT SPIRTAS, NANCY J. ALEXANDER. (1995) Do Fertility Drugs Cause Ovarian Tumors?. Journal of Women's Health 4:3, 247-259
CrossRef203
ELAINE RON, BRUNO LUNENFELD. (1995) A Review of Infertility and Its Treatment in the Etiology of Female Reproductive and Other Cancers. Journal of Women's Health 4:3, 261-272
CrossRef204
MIMI MEYERS, RONNY DIAMOND, DAVID KEZUR, CONSTANCE SCHARF, MARGOT WEINSHEL, DOUGLAS S. RAIT. (1995) An Infertility Primer for Family Therapists:. I. Medical, Social, and Psychological Dimensions. Family Process 34:2, 219-229
CrossRef205
(1995) Risk of Ovarian Cancer after Treatment for Infertility. New England Journal of Medicine 332:19, 1300-1302
Full Text206
Guillermo Tortolero-Luna, Michele Follen Mitchell. (1995) The epidemiology of ovarian cancer. Journal of Cellular Biochemistry 59:S23, 200-207
CrossRef207
Jean-Yves Nau. (1994) French surveillance of ovarian cancer. The Lancet 344:8930, 1147-1148
CrossRef208
Whittemore, Alice S., . (1994) The Risk of Ovarian Cancer after Treatment for Infertility. New England Journal of Medicine 331:12, 805-806
Full Text
- Letters
