Michel De Vos

Fertility Following Fertility-Sparing Surgery for Borderline Ovarian Tumors

AbstractBorderline ovarian tumors (BOTs) are commonly diagnosed in women of reproductive age, raising concerns about the impact of surgical management on fertility. This review explores the role of fertility-sparing surgery (FSS) and fertility preservation (FP) strategies in young women diagnosed with BOTs. While FSS carries a slightly higher risk of recurrence compared to bilateral salpingo-oophorectomy, there is growing evidence supporting the safety of FSS, with no adverse effects on 10-year overall survival. In light of this, recent multidisciplinary guidelines recommend FSS for BOT at all stages. A significant proportion of women with BOTs report infertility prior to diagnosis, suggesting a possible pathophysiological link between reduced reproductive fitness and the development of BOT. The potential association between ovarian stimulation (OS) and an increased risk of BOT remains controversial, with current evidence failing to establish a definitive causal link. For women with recurrent stage I BOT and no evidence of peritoneal disease on imaging, OS followed by oocyte retrieval is a viable option before definitive surgery. Notably, a history of BOT does not significantly affect pregnancy outcomes following IVF. FP counseling is essential to tailor treatment plans that address both oncological and reproductive needs in patients undergoing FSS for BOT.