Sterilitätsbehandlung, ovarielle Stimulation und Malignome L. Wildt Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin Department für Frauenheilkunde Medizinische Universität Innsbruck

Ovarielle Stimulation und Malignome Studienlage und Probleme Ovarielle Stimulation und Malignome Prädisponierende Faktoren und Malignome Case reports

Ovarielle Stimulation und Malignome – Probleme I Änderungen der Stimulationsprotokolle Änderungen der Präparate (Clomid, GnRH-Agonisten und Antagonisten ,rekombinante /urinäre Präparate Kontrollgruppe (ist Infertilität per se ein Malignomrisiko?)

Ovarielle Stimulation und Malignome – Probleme II Art der Sterilitätsbehandlung (ivF-IUI-VZO) Erfolg der Sterilitätsbehandlung Ursache der Sterilität? Qualität der Abklärung ? Male Factor ?

Ovarielle Stimulation und Malignome Studienlage und Probleme Ovarielle Stimulation und Malignome Prädisponierende Faktoren und Malignome Case reports

Mammakarzinom Ovarialkarzinom Bordeline Ovarialtumore Endometriumkarzinom Sonstige: Zervixkarzinom, Melanom, Kolonkarzinom; SD - Karzinom

Schlussfolgerung Die ovarielle Stimulation mit Clomid und /oder Gonadotropinen erhöht das Mamma-Ca- Rsiko offenbar nicht

Is endometriosis a risk factor of cancer, and what is the effect of IVF on that risk?

Endometriose The synchronous occurrence of endometriosis with endometrioid, clear cell, and mixed subtypes of ovarian cancers suggests transformation of endometriosis constituents into tumor cells. Ness et al, AM J Obstet Gynecol 2003 OR 1,73 95% CI, 1,10 – 2,71 Ness et al, Am J Epidemiol 2002 Environmental factors and medical conditions that increased risk included talc use, endometriosis, ovarian cysts, and hyperthyroidism. Ness et al, Epidemiol 2000 The possibility that ovulation induction increases the risk of ovarian cancer remains unproven. However, recent studies suggest that both infertility and endometriosis may be independent risk factors. Burmeister L, Healy DL Ann Med 1998

Ovarielle Stimulation und Malignome Studienlage und Probleme Ovarielle Stimulation und Malignome Prädisponierende Faktoren und Malignome Case reports

Conclusion 1: No increased risk for breast cancer in comparison with the general population and the control group Increased risk of endometrial cancer in both the IVF group and control group. Since the increase in risk of endometrial cancer was observed in both IVF and Control groups, an effect of subfertility itself is likely The next step is to use the Cox regression analysis to determine the effect of exposure to IVF and various characteristics on the risk of breast cancer, ovarian cancer and endometrial cancer. After adjustment for age at end of follow-up, parity, previous FD use and previous inseminations the RR for both breast cancer and ovarian cancer were close to one. The risk for endometrial cancer decreased after adjustment for confounders to 0.44.

Conclusions 2: There is NOT a significant and increased risk of ovarian cancer after IVF There is an increased risk of BTO in the IVF group within one, and after 5 yrs (although the number of cases in the control group is low) The risk appears to correlated with the IVF procedure Endometriosis is a risk factor of ovarian cancer and is NOT correlated with IVF (RR 4.9 ( CI 1.0-14.0 ) The next step is to use the Cox regression analysis to determine the effect of exposure to IVF and various characteristics on the risk of breast cancer, ovarian cancer and endometrial cancer. After adjustment for age at end of follow-up, parity, previous FD use and previous inseminations the RR for both breast cancer and ovarian cancer were close to one. The risk for endometrial cancer decreased after adjustment for confounders to 0.44.

Ovarielle Stimulation und Malignome Prädisponierende Faktoren und Malignome Case reports

Case report I 37a Patientin, Kiwu seit 18a, prim Sterilitas, BMI 23 App. perforata als Kind 1992 Lap auswärts: Adhäsiolyse, Ovarialcyste 1998 op. HSK: subendometrialer Cyste (Histo: Endometríose ?) HSG: Hydrosalpinx li, re ? 8x IVF: (5x long, 1x Anta; 7x HMG, 1x FSH) zuletzt 10/03 09/06: Vorstellung wegen seit 6 Monaten vag. Fluor (z.T. fleischwasserfarben) CT kl. Becken 06/06: Verdacht auf Hydrosalpinx li DD Pseudocyste CEA, CA 125: 0,7/15,5

Case report I 11/06 Lap.: Dg.: Adhäsiones permagna, Hydrosalpinx re, Hämatosalpinx li Op.: Adhäsiolyse,Tubektomie bil Histo: Tubenkarzinom li G III 12/06 Re Lap: He + Ovarektomie bil pelv. Lymphonodektomie Hemicolektomie Histo: pT1a, GIII, N0 weitere Ko: oB

Case report II 35a Patientin, Kiwu seit 3a, sek. Sterilitas, BMI 25 05/05 op LASK: Adhäsiolyse, Neostomie re 01/06 Sono IVF: cyst/solider Tu li 02/06 CT/NMR: Befund idem CA 125: 17,6 05/06 op LASK: 2x Cystenexstirpation li Ovar (SS), multiple PE`s Histo (SS): Teratom, Cystadenofribrom Histo (revidiert): borderline Tu, Figo IIa

Case report II 07/06: long protocol (Suprecur/rFSH) ad ICSI 9EZ, 5BZ → Kryo! 09/06 Lap: Adenexektomie li (SS) Tubektomie dext, Ovarialteilresktion re, Adhäsiolyse, Omentumresektion, AE, Implantresektion Histo: Figo II a, Omentum, App.+Zyto: neg 01/07: CT/NMR: oB, CA 125: oB 01/04//07: 2x TET (2BZ) → neg 09/07: Stimulation ad ICSI, CA 125: 7,8 (AMH: 5,02 → 0,84) Geplant: falls neg. → Re LASK