Objective: To determine whether women with epithelial ovarian cancer a
re more likely to have been exposed to fertility drugs, and in particu
lar hMG, than healthy population controls. Design: A nationwide case-c
ontrol study. Patients: Two hundred living women 36 to 64 years of age
, with a histologically confirmed diagnosis of primary invasive or bor
derline epithelial ovarian cancer that was first diagnosed and reporte
d to the Israel Cancer Registry between January 1, 1990 and September
1, 1993 were enrolled. There were 164 (82%) invasive and 36 (18%) bord
erline epithelial ovarian tumors among the 200 cases. The controls wer
e 408 women from the same dialing areas selected by random digit diali
ng. Cases and controls were interviewed using a standard questionnaire
. A multivariate logistic model was used to assess the association of
fertility drug use and ovarian cancer, controlling for variables found
to be statistically associated with this outcome on univariate analys
is. Results: Twenty-four women with epithelial ovarian cancer (12%) an
d 29 healthy controls (7.1%) reported that they had used any fertility
drug (adjusted odds ratio [OR] 1.31; 95% confidence interval [CI] 0.6
3 to 2.74). Among cases and controls, respectively, 22 and 24 reported
that they had used hMG alone or in combination with clomiphene citrat
e (adjusted OR 1.42, 95% CI 0.65 to 3.12), and 11 and 6 reported that
they had used hMG alone (adjusted OR 3.19, 95% CI 0.86 to 11.82). The
risk was increased particularly in the subgroup of women with borderli
ne ovarian tumors who had used hMG (adjusted OR 9.38, 95% CI 1.66 to 5
2.08). Conclusions: We conclude that the use of ovulation induction ag
ents, in particular hMG, may increase the risk of epithelial ovarian t
umors.