Oocyte cryopreservation in two women with borderline ovarian tumor recurrence.
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FERTILITY PRESERVATION
Oocyte cryopreservation in two women with borderline ovarian tumor recurrence. Francesca Filippi 1 & Fabio Martinelli 2 & Edgardo Somigliana 1,3 & Dorella Franchi 4 & Francesco Raspagliesi 2 & Valentina Chiappa 2 Received: 18 December 2019 / Accepted: 28 February 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Borderline ovarian tumors (BOTs) commonly occur during reproductive years. Given the good prognosis, fertility-sparing surgery can be considered in young women wishing to preserve their fertility. However, conservative management exposes patients to the risk of recurrence. In these cases, the new surgery may be radical (completing the removal of both adnexa) or, when conservative, it may be associated with relevant damage to the ovarian reserve. In this study, we report on two women who decided to perform ovarian hyper-stimulation and oocyte cryostorage at the time of the diagnosis of recurrence, but before undergoing the new surgery. They both obtained a satisfactory number of oocytes, the retrieval was unremarkable, and no main detrimental effects on the ovarian lesions were noticed. These two cases suggest that ovarian hyper-stimulation and oocyte retrieval before planned surgery for BOT recurrence is a feasible option. Keywords Borderline ovarian tumor . Oocytes . Fertility preservation
Introduction Borderline ovarian tumors (BOTs) are peculiar epithelial ovarian neoplasms that commonly occur in young women [1, 2]. Given their good prognosis, fertility-sparing surgery can be considered in young women wishing to preserve their fertility [3]. However, this approach exposes patients to the risk of recurrence [4, 5]. According to a recent systematic review, this risk is about 13% (95%CI, 10–16%) [5]. In this scenario, we previously advocated fertility preservation after first surgery in order to store oocytes that could be used in case of recurrence requiring castrating surgery [3]. However, only a minority of affected women may benefit
* Edgardo Somigliana [email protected] 1
Infertility Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via M. Fanti, 6, 20122 Milan, Italy
2
Gynaecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
3
Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
4
Preventive Gynaecologic Oncology Unit, IEO, Milan, Italy
from this approach. Most women with a history of surgery for BOT conceive naturally [5]. In fact, a policy of systematic fertility preservation following first surgery would uselessly expose a consistent proportion of women to the risks of fertility preservation procedures and could cause a significant wastage of financial resources. In this study, we propose a new strategy that was not previously foreseen. Specifically, given the impressive progress of transvaginal ultrasound in properly detecting and diagnosing BOT recurrences [6], we suggest to cryopreserve oocytes only in case of recurrence and prior to
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