Ovarian tumors in a cohort of infertile women

N Engl J Med. 1994 Sep 22;331(12):771-6. doi: 10.1056/NEJM199409223311204.


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.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Case-Control Studies
  • Clomiphene / adverse effects*
  • Clomiphene / therapeutic use
  • Cohort Studies
  • Confidence Intervals
  • Female
  • Follow-Up Studies
  • Humans
  • Infertility, Female / drug therapy*
  • Infertility, Female / epidemiology
  • Middle Aged
  • Ovarian Neoplasms / chemically induced*
  • Ovarian Neoplasms / epidemiology
  • Regression Analysis
  • Risk
  • Washington / epidemiology


  • Clomiphene