Ovarian epithelial dysplasia in relation to ovulation induction and nulliparity

Objective. The goal of this study was to assess the relationship between ov ulation induction, nulliparity, and ovarian epithelial dysplasia. Methods. This retrospective cohort study was performed in one teaching and one district general hospital in London. The subjects, 83 women who had und ergone hysterectomy and bilateral oophorectomy and whose ovaries were repor ted as "normal," were divided into three groups: ovulation induction (13), nulliparity (20), and fertile controls (50). These ovaries were independent ly reviewed by two pathologists who assigned a score of 0, 1, or 2 to nine epithelial cytological and architectural features. The main outcome measure was the total dysplasia score, which was used to quantify the degree of ov arian epithelial abnormality in the three groups. Results. The mean dysplasia score was significantly higher in the women who had undergone ovulation induction than in the fertile controls (7.92 vs 5. 70, P = 0.012). The magnitude of the difference between the ovulation induc tion group and controls remained similar after adjusting for age, parity, a nd duration of oral contraceptive use (2.17, 95% CI: -0.11-4.44). However, the statistical significance of this difference was reduced (P = 0.062). We did not find any evidence of a difference in dysplasia score between nulli parous women and controls, neither before (P = 0.85) nor after adjusting fo r age and duration of oral contraceptive use (P = 0.87). Conclusions. These results suggest a possible association between ovarian e pithelial dysplasia and ovulation induction therapy, in accord with previou s reports of increased risk of ovarian cancer in women with a history of fe rtility treatment. The higher dysplasia score could be attributable to the drugs used to induce ovulation or to a genetic susceptibility to ovarian ca ncer. (C) 2001 Academic Press.