Review

Fertility sparing options for women with ovarian neoplasms

Zygouris Dimitrios1, Panagopoulos Perikles1, Christodoulaki Chrysi1, Vrachnis Nikolaos2, Georgiou Athanasios1, Chrelias Charalampos1

13rd Department of Obstetrics and Gynecology, University of Athens, Medical School, Attiko hospital
22nd Department of Obstetrics and Gynecology, University of Athens Medical School, Aretaieio hospital

Correspondence: Zygouris Dimitrios, Papazoglou16, Ioannina, GR – 45444, Greece, E – mail: dzygouris@hotmail.com


Abstract

Ovarian cancer is the leading cause of death by gynecological cancer and it is estimated that up to 17% of cases occur in women less than 40 years. In these patients it is often vital to maintain their fertility. This can be achieved using either fertility sparing types of surgery under strict selection criteria, or in combination with methods of assisted reproduction. In any case this should be avoided in patients over 40 years, and patients should be fully aware of the potential oncology and reproductive outcome. It is also needed a comprehensive surgical staging and patient’s acceptance of a very close postoperative follow up. For patients with borderline tumor fertility sparing surgery is a safe option, with high percentages of achieved pregnancies and can be used either ovarian stimulation or ovarian tissue cryopreservation. In cases of invasive epithelial ovarian cancer fertility sparing clearly raises more concerns. The fertility surgery is recommended for patients with stage IA and low risk factors and under strict conditions for stages IB and IC, but beyond it is not considered safe choice. After surgery, pregnancy can be achieved by natural conception or assisted reproduction. In recent years there is growing debate on in vitro maturation of oocytes and growth to maintain fertility, making it a promising alternative. Furthermore,
cryopreservation of ovarian tissue is discussed and has found application in several experimental studies, but without sufficient data.In conclusion, we should mention that many methods are at an early stage and clinicians should always personalize each patient’s treatment and provide full information about the chances of disease recurrence and the percentages of getting pregnant.

Keywords: epithelial ovarian cancer, borderline ovarian tumor, fertility sparing, ovarian neoplasms

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