OVARIAN STIMULATION AND GRANULOSA-CELL TUMOR

Ovarian stimulation in the treatment of infertility is far from physio logical because patients and their ovaries are exposed to high concent rations of gonadotropins. Many studies have focused on the two most co mmon side-effects of ovarian stimulation-ie, hyperstimulation and mult iple pregnancy. We describe 12 patients in whom granulosa-cell tumour was discovered after ovarian stimulation treatment with clomiphene cit rate and/or gonadotropins. Although we cannot prove a causal link betw een the tumour and the medication, investigations in animals have show n a relation between gonadotropin exposition and the development of gr anulosa-cell tumours. The possible relation of ovarian stimulation and granulosa-cell tumours in human beings has not been published before. We postulate three explanations for this finding; first, the granulos a-cell tumour is present in the ovary, waiting for a hormonal trigger; second, increased follicle stimulating hormone concentrations are onc ogenic to granulosa cell; and third, the onset of the granulosa-cell t umour during ovarian stimulation is coincidental. We recommend that ov arian stimulation is done only if there is a valid indication after pr oper assessment of the ovaries, and that women who have had ovarian st imulation are followed for longer than at present.