- Design
- Systematic review and meta-analysis of observational studies, GRADE-rated
- Population
- 12 studies, 3,733,499 women, 219,357 exposed to fertility treatment
- Primary outcome
- Incident melanoma
- Effect
- HR 1.24 (95% CI 1.02 to 1.50), prediction interval 0.97 to 1.58; very low certainty
A meta-analysis pooled 12 observational studies including 3,733,499 women, 219,357 of whom had fertility treatment, to estimate melanoma risk. No study was judged at low risk of bias, mainly because ultraviolet exposure was poorly accounted for.
Fertility treatment overall was associated with a modest rise in melanoma (HR 1.24, 95% CI 1.02 to 1.50; I-squared 0%), but the prediction interval ran from 0.97 to 1.58. The signal was stronger for drug-only ovulation induction (HR 1.39, 1.01 to 1.92) and near-null for IVF and assisted reproduction (HR 1.09, 0.81 to 1.48). In absolute terms that is roughly 3 to 8 extra melanomas per 10,000 women over 10 years. Certainty was very low to low throughout.
Women who have fertility treatment may differ in sun exposure, skin checks and other factors, which could explain much of this. The authors conclude that fertility practice should not change.
For a dermatologist, this is a reason to give a reassuring, accurate answer when asked, and to apply the usual melanoma risk assessment rather than a new screening rule.
- If asked, explain that any added melanoma risk from fertility treatment looks small and uncertain.
- Assess melanoma risk by the usual factors: skin type, naevus count, family history, sun exposure.
- Do not start extra skin surveillance on the basis of fertility treatment alone.
- IVF itself showed no clear association in this analysis.
Why it matters
Patients ask this question, and the honest answer is reassuring.
Don't overread it
These were observational studies with poor control of sun exposure; they cannot show fertility drugs cause melanoma.
The statistics, in plain English
An HR of 1.24 means about a quarter higher relative risk, but melanoma is uncommon, so the absolute increase is a few cases per 10,000 women over a decade. The prediction interval crossing 1 means a future study could find no association at all.
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