Risk Of Ovarian Neoplasms In Women After Treated With In Vitro Fertilization-Embryo Transfer: A Meta-analysis

Objective:To evaluate the relative risk of ovarian neoplasms in infertile women after treated with in vitro fertilization-embryo transfer.Methods: A comprehensive database search,including Embase,Pub Med,Web of Science,CNKI,VIP,Sinomed and Cochrane Library were carried out on IVF-ETicles about association between assisted reproductive technologies and ovarian neoplasms published from July 1st,1978 to March 31 th,2020.And then literatures were screened and assessed before extraction data for meta-analysis.Results: In this analysis,17 cohort studies and a total of 6 975 147 women were included,tatol 7523 cases of ovarian neoplasms were reported,including787 cases in IVF-ET group and 6736 cases in non IVF-ET group.The overall meta-analysis indicated that infertile women with IVF-ET increased the risk of ovarian neoplasm,compared with non IVF-ET group(OR=1.40;95%CI:1.28-1.54).The subgroup analysis based on histological subtype of ovarian neoplasms,we discovered a significantly positive association between IVF-ET and risk of ovarian cancer(OR=1.70;95%CI:1.43-2.02),as well as borderline ovarian tumors OR=1.67;95% CI:1.31-2.12).In subgroup analysis for infertility,compared with women with infertility without IVF-ET,the risk of ovarian neoplasms was significantly increasing in IVF-ET group(OR=1.48;95%CI:1.18-1.84).Besides,the subgroup analysis according to follow-up time,with an average follow-up time of no more than 7 years shown no significant increase(OR=1.10;95%CI:0.78-1.54),however with a follow-up time of more than 7years,the risk of ovarian neoplasms in IVF-ET group was uncommonly elevated(OR=1.43;95%CI: 1.30-1.58).The subgroup analysis of the annual incidence rate,a extremely positive association was observed between the risk of ovarian tumors and IVF-ET(OR=1.82;95%CI:1.55-2.12).According to the subgroup analysis of live births existed or not,the risk of ovarian tumor after IVF-ET is obviously higher than control group(or = 0.65;95% CI: 0.40-1.06).In the subgroup analysis based on the times of ovarian stimulation cycles,no significant increase was found on the the risk of ovarian tumor in multiple ovarian stimulation cycles compared with 1-2 ovarian stimulation cycles(or = 0.99;95% CI: 0.77-1.29).The subgroup analysis of the times of embryo transfers showed that multiple embryo transfers compared with 1-2 embryo transfers was not significantly the risk of ovarian tumor in(or = 0.89;95% CI: 0.56-1.41).Conclusion(s): Compared with the non IVF-ET group,the risk of ovarian neoplasms was increased after IVF-ET,especially ovarian cancer and ovarian borderline tumor.Moreover,by contrast to infertility control group without IVFET,risk of ovarian neoplasms was elevated after IVF-ET.Although our results indicated that live births after IVF-ET were related to a reduced risk of ovarian neoplasms,no statistical significance was seen.The number of ovarian stimulation cycles and embryo transfer times statistically had no significant effect on the risk of ovarian cancer.