Pathological conditions predisposing to infertility and gynaecological neoplasia

Abstract

Some of the conditions long blamed for female factor infertility are now acknowledged as well established risk factors of gynecological neoplasia. This realization has lead to the proposition that infertility might be a risk factor for the development of several types of gynecological neoplasms. This review addresses different conditions that play a role in both infertility and gynaecological neoplasia. An intricate interplay between growth factors and hormonal factors (estrogens and progestins, androgens and gonadotropins) is said to link the state of infertility to some gynecological tumors. The relation between endometriosis -as one of the well established causes of female infertility - and ovarian cancer is well known. Endometriosis has been particularly related to endometrioid and clear-cell ovarian carcinomas. Another evidence for this association is embodied in finding endometriotic lesions adjacent to ovarian cancers. The polycystic ovary syndrome (PCOS), one of the most prevalent endocrine disorders and a long studied cause of female infertility increases the risk of endometrial carcinoma. The link between PCOS and endometrial carcinoma seems to be endometrial hyperplasia. PCOS-associated endometrial carcinoma tends to present at a younger age and early stage, with lower grade and lower risk of metastasis. Turner’s syndrome and other types of ovarian dysgenesis constitute a rare cause of infertility and are known to confer a definite risk of germ cell tumors. There seems to be a link between infertility and an increased risk of gynecological neoplasia. Hence, it is important to assess the risk of malignancy in each category of infertile patients so as to provide optimal and timely intervention.

Keywords: Infertility-gynecological cancer, Endometriosis, Polycystic ovary syndrome, Ovarian dysgenesis, Endometrioid carcinoma, Clear cell carcinoma, Turner’s syndrome, Gonadoblastoma, Hyperestrogenemia

Core tip: Female infertility is now acknowledged as a risk factor of gynecological neoplasia. In this mini-review we conduct a comprehensive literature review to verify this prospect. The principal pathogenetic mechanisms linking infertility to gynecological neoplasia are pointed out. The relationship between each of endometriosis and polycystic ovary syndrome and gynecological neoplasia is explored in depth. We discuss the relation of Turner’s syndrome (the prototype of ovarian dysgenesis) to gynecological cancer. Is there a relation between increased risk of ovarian cancer and ovulation-stimulation drugs? We will attempt to answer this question.