MNGI-09. FERTILITY TREATMENT AND MENINGIOMA INCIDENCE

Abstract

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. 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. 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 (3.8%). 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). A history of fertility treatment is common in female patients presenting with meningioma. 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 importance of assessing for 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.