Clinical Recommendation on Fertility Preservation in Borderline Ovarian Neoplasm: Ovarian Stimulation and Oocyte Retrieval after Conservative Surgery

Abstract

Aim: To evaluate safety and fertility outcome after assisted conception in patients who were treated conservatively for a borderline ovarian tumor (BOT). Methods: A systematic literature review using Medline was conducted. From all the relevant case series the following information was obtained for each reported patient: primary diagnosis; disease stage; surgical treatment; duration of follow-up; incidence of recurrence; current disease status; the number of controlled ovarian stimulation cycles and/or oocyte retrievals, and successful pregnancies. Results: Overall 588 articles were screened, of which finally 15 reports including 62 patients met the inclusion criteria. Within a median follow-up duration of 52 months in this small group of patients, overall 12 patients (19.4%) had recurrences, and those recurrences were again successfully treated by surgery in 11 patients. In terms of assisted reproductive outcome, in our series overall 152 ovarian stimulation cycles as well as 135 oocyte retrievals were performed with a baby-take-home rate of 28.3% per stimulated cycle. Conclusion: It is mandatory to counsel all patients with a history of BOT who are seeking treatment for infertility that, due to the limited data, it is unclear whether assisted reproductive techniques are associated with an increased risk of recurrence.

Twenty-five-year-old Woman with Bilateral Borderline Ovarian Tumour Desiring to Preserve Fertility – Case Report and Literature Review on the Current State of Fertility Preservation in Women with Borderline Ovarian Tumours

“…All in all, very few studies focus on stimulation therapy in women with borderline tumours. In a study conducted by Denschlag et al with 62 women and 152 treatment cycles, the recurrence rate of 19.4 % after 52 months was comparable to the rate reported by Zanetta et al [20]. Some other authors recommend that women with borderline tumours who are basically capable of spontaneous conception should wait 1 or 2 years before becoming pregnant, since most recurrences of borderline ovarian tumours occur within 24 months of treatment [7].…”

Fertility preservation in women—a practical guide to preservation techniques and therapeutic strategies in breast cancer, Hodgkin’s lymphoma and borderline ovarian tumours by the fertility preservation network FertiPROTEKT

“…According to a review of the studies published up to now, the risk of relapse of a borderline tumour after ovarian stimulation treatment was 19.4% ( n  = 12/62) [37]. However, none of these relapses resulted in death.…”

Fertility-Sparing Surgery for Young Women with Early-Stage Epithelial Ovarian Cancer

“…Although the oncologic and reproductive outcomes after fertility-sparing surgery are relatively well established in women with borderline ovarian tumors and malignant ovarian germ cell tumors, they have not yet been defined in women with early-stage EOC [15,16,17,18]. Here, therefore, we review current knowledge related to the oncologic and reproductive outcomes after fertility-sparing surgery in young women with early-stage EOC and propose acceptable indications for fertility-sparing surgery in these patients.…”