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  • Fertility Treatment and Meningioma

    Final Number:
    1277

    Authors:
    Maryam Nour Shahin; Stephen T Magill MD, PhD; Cecilia L. Dalle Ore BA; Pamela N. Peters MD; Jennifer Viner CNRN, NP; Michael William McDermott

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Meningiomas are more common in females and 70-80% express the progesterone receptor. They have been reported after gender reassignment therapy, suggesting that high-dose exogenous estrogen/progesterone exposure, such as occurs during fertility treatments, may increase the risk of developing a meningioma. The goal of this study was to report the incidence of prior fertility treatment in a consecutive series of female patients presenting with meningioma.

    Methods: A retrospective review of patients presenting with meningioma from 2015-2018 was conducted. Female patients with prior fertility treatments were compared to those who did not receive fertility treatment using standard statistical methods.

    Results: Of 206 female patients with meningioma, 26 (12.6%) had a history of fertility treatments. Patients underwent various forms of assisted reproductive technology including: in vitro fertilization (50.0%), clomiphene with or without intrauterine insemination (34.6%), and unspecified (19.2%). One patient (3.8%) received supplemental progesterone during her treatment. The most common presenting symptoms were incidental (57.7%) and headache (26.9%). Median follow up was 1.8 years. Tumors were WHO grade I (78.6%) or grade II (21.4%). Patients who underwent fertility treatments presented at significantly younger mean age compared to those who had not (51.8 vs 57.3 yrs, p = 0.0135, 2-tailed T-test) and were more likely to have multifocal (OR: 4.5, 95% CI: 1.4-14.8, p = 0.0196) and non-skull base meningiomas (OR: 4.4, 95% CI: 1.7-11.4, p = 0.0012).

    Conclusions: A history of fertility treatment is common in female patients presenting with meningioma. Furthermore, patients with meningioma and a history of fertility treatment were more likely to present at a younger age and have multifocal and non-skull base tumors. These findings stress the need for assessment of prior estrogen/progesterone exposure in patients presenting with meningioma. Future large prospective series and laboratory investigations are needed to determine the impact of fertility treatment on meningioma development.

    Patient Care: This study raises awareness of the importance of assessing estrogen/progesterone exposure among patients presenting with meningioma, which will lead to future prospective clinical registry-based studies and laboratory investigations that are needed to determine how fertility treatments affect a patient's risk for developing meningioma.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the incidence of prior fertility treatment among female patients presenting with meningioma. 2) Discuss the meningioma locations most commonly found in patients with a history of fertility treatment. 3) Incorporate history of estrogen/progesterone exposure when working up patients with a new diagnosis of meningioma.

    References:

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