The largest study to date on women with borderline ovarian tumours shows that fertility can be preserved if conservative surgery is used, a scientist said at the 21st annual conference of the European Society for Human Reproduction and Embryology. Dr. Christophe Poncelet, from the UFR SMBH Léonard de Vinci, Université Paris XIII, Bobigny, France, said that the research mean that women could choose to preserve their fertility by having only one ovary removed.
Borderline tumours make up about 15% of all epithelial ovarian tumours. They are also called tumours of low malignant potential because they are less likely to spread. "Little was known regarding fertility determinants after conservative treatment for BOT", said Dr. Poncelet, "and we thought it was important both for our practice and for patients' outcomes to identify specific parameters influencing subsequent fertility. We also wanted to see how surgical management of these tumours would influence recurrence."
The scientists looked at data on 360 women with BOT, of whom 162 underwent conservative surgery, and compared those who conceived and those who tried but failed. 30 pregnancies occurred in 21 of the 65 women who wished to conceive after conservative treatment – 27 spontaneous pregnancies, 3 after ovarian stimulation, 1 after intrauterine insemination and 2 after IVF. The women who conceived tended to be younger than those who did not, and they were also more likely not to have conceived before.
However, the recurrence rate with conservative surgery was quite high at 16.6% over an average 70-month period. "But we would recommend conservative surgery for younger women with unilateral BOT", said Dr. Poncelet. "Our data underlines the fact that it is an adequate option for these women, particularly if they wish to become pregnant. There was no difference in the recurrence rate between those who conceived and those did not, nor in time to recurrence."
Dr. Poncelet and his team hope to follow up the work with a prospective observational study – one where patients are watched and followed up for subsequent development of disease. "These results were obtained from a retrospective study", he said, "and it would be interesting to look at outcomes in real time, particularly where ovarian stimulation and ART are involved in pregnancies. Specific data concerning the influence of ovarian hyperstimulation on the recurrence rate are not available, and it is important to determine this.
"Another option would be to create a register of all pregnancies obtained after conservative treatment for BOT or early stage ovarian cancer," he said.
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