Oncofertility outcomes after fertility-sparing surgery in infertile BOT patients: results of a large retrospective study on controlled ovarian stimulation

TL;DR

This study shows that fertility treatments after surgery for borderline ovarian tumors are safe and effective if certain guidelines are followed.

Contribution

The study identifies specific guidelines for controlled ovarian stimulation that reduce recurrence risk in borderline ovarian tumor patients.

Findings

The recurrence rate of borderline ovarian tumors after fertility-sparing surgery was 20.5%.

A live birth rate of 57.5% was achieved in infertile borderline ovarian tumor patients undergoing IVF.

Delaying IVF initiation and limiting gonadotropin administration reduced recurrence risk.

Abstract

The optimal management of borderline ovarian tumors (BOTs), particularly the safety and efficacy of in vitro fertilization (IVF) following fertility-sparing surgery (FSS), remains controversial. This study aimed to evaluate the impact of controlled ovarian stimulation (COS) on oncofertility outcomes in infertile women with BOT after FSS.

This retrospective observational study was conducted at the Reproductive Medical Center, Peking University Third Hospital (Beijing, China) and included 73 infertile BOT patients who underwent IVF between January 2008 and June 2022.

Median follow-up was 61.0 months (range: 7.0–156.0 months). The BOT recurrence rate was 20.5% (15/73), and the cumulative live birth rate per patient was 57.5% (42/73). There were no significant differences in the number of COS cycles (P=0.513) or total dose of gonadotropin (Gn) (P =0.183) between the recurrence and non-recurrence groups. Multivariate analysis identified three independent predictors of oncologic outcomes: interval from surgery to first IVF (HR: 0.07; 95% CI: 0.01–0.44; P =0.004), duration of Gn administration (HR: 9.70; 95% CI: 1.37–68.70; P =0.023), and live birth (HR: 7.02; 95% CI: 1.35–36.41; P=0.020).

In infertile BOT patients undergoing FSS, IVF significantly improves pregnancy outcomes. COS can be safely conducted post-FSS without increasing recurrence risk, provided initiation is delayed ≥3 months postoperatively and Gn administration is limited to ≤13 days.

Figures