Borderline ovarian tumors and fertility

Abstract

Borderline ovarian tumors (BOTs) are a distinct diagnostic category of epithelial ovarian tumors, distinguished from both benign and invasive epithelial ovarian tumors. Because they affect young women of childbearing age, are diagnosed at an early stage, and are associated with excellent prognosis, fertility-sparing options are often used. In this review, we discuss recent findings on the outcomes of fertility-sparing treatments in patients with BOTs. Reports on the use of fertility-sparing surgery in patients with advanced-stage BOTs and on the application of laparoscopy in fertility-sparing surgery are increasing. As potential alternative, experiences on ovarian tissue cryopreservation have been reported. Fertility-sparing surgery is the best option to preserve childbearing capacity in young patients with BOTs. Fertility-sparing surgery is well tolerated not only in patients with early-stage BOTs but also in patients with advanced-stage BOTs with noninvasive extraovarian implants, if these implants can be resected completely. After fertility-sparing surgery, pregnancy outcomes are promising and most pregnancies are achieved spontaneously. There are few complications associated with pregnancy, and subsequent pregnancy seems to have little impact on disease course. Fertility drugs are well tolerated in patients with infertility after fertility-sparing surgery for early-stage BOTs, but caution should be exercised when using these drugs after surgery in patients with advanced-stage BOTs. If fertility-sparing surgery is technically not feasible owing to extensive tumor involvement of both ovaries, recent artificial reproductive technologies can be considered, including embryo, oocyte, and ovarian tissue freezing; use of donor oocytes; and surrogacy, but more experience with these options is required.