Fertility preservation strategies in borderline ovarian tumor recurrences: different sides of the same coin

Excerpt

Borderline ovarian tumors (BOT) account for 10–20% of all ovarian epithelial tumors, with one-third of cases diagnosed under the age of 40 [1]. Fertility-sparing surgery (FSS) can be offered to patients who wish to spare their reproductive potential, even if the overall risk of recurrence after FSS is higher (0–25%) than after bilateral salpingo-oophorectomy (0–5%) [2, 3]. The management of patients who recur after FSS is challenging. Although a second FSS can be offered [4, 5], repeated surgery may reduce healthy ovarian parenchyma, increasing the risk of infertility [6]. Moreover, the occurrence of postoperative adhesions might interfere with fallopian tube function [7]. Thus, for a patient undergoing FSS and interested in having a pregnancy, the best option is to achieve pregnancy through spontaneous conception immediately after first surgery, acknowledging the higher recurrence rate during the first 2 years [8‐10] and that pregnancy does not increase this risk [11‐14]. In situations involving a personal history of infertility or when reproduction is not desired by patients yet, the most appropriate plan B is to rely on assisted reproductive techniques (ARTs), with oocyte harvesting and cryopreservation after FSS [15]. …