Assisted reproductive technology and uterine cancer risk. A systematic review and meta-analysis

Abstract

BACKGROUND: The problem of infertility has not only medical, but also socio-demographic significance. To date, the global scale of the spread of various forms of infertility is beyond doubt among specialists around the world. This, in turn, causes an increase in the frequency of prescribing assisted reproductive technologies, but the question of the relationship between the prescribing of drugs used to treat infertility and the risk of developing cancer of the uterine body remains poorly understood. AIM: The aim of this study was to assess the possible relationship between in vitro fertilization, the use of ovulation stimulation drugs and the risk of developing uterine cancer in women with infertility. MATERIALS AND METHODS: This literature systematic review is based on resources from the following databases: Medline, ClinicalKey, Google Scholar, Embase, the Cochrane Library, and eLIBRARY for the period 19992022. The search for publications was carried out using keywords defined in accordance with the PICO principle (P, population or patients; I, intervention; C, comparison; O, outcomes): female, women, infertility, infertility treatment, in vitro fertilization, IVF, assisted reproductive technology, ART, ovarian stimulation, ovarian hyperstimulation, clomiphene citrate, hCG, hMG, tamoxifen, uterine, endometrial, cancer, carcinoma neoplasm, uterine neoplasm. The following SQL operators were used during the search: AND and OR. RESULTS: The search resulted in 37 representative publications, with eight studies selected for meta-analysis. CONCLUSIONS: This systematic review and meta-analysis have demonstrated the ambiguity of the design and results of studies on the possible relationship of uterine cancer and assisted reproductive technology methods published to date. The issue under review is urgent due to the high frequency of infertility and an increase in the frequency of gynecologic cancers. The conducted studies confirm that it is impossible to evaluate the carcinogenic effect of ovulation inducers or in vitro fertilization methods without adjusting for the infertility factor, as well as risk factors for uterine cancer. There is still a high need for further research, particularly for studying the safety profile of infertility treatment methods in relation to long-term cancer risks.