[Assisted reproductive technologies after conservative management of borderline or invasive ovarian tumours].
OBJECTIVE
Ovulation induction, the usual resort of Assisted Reproductive Technologies (ART), has been suspected of carrying a responsibility in the genesis of ovarian tumours. For patients with a borderline or invasive ovarian tumour, treated by conservative surgery and desiring to become pregnant, the problem is thus of a possible resort to the Assisted Reproductive Technologies.


METHODS
This is a multicenter, national and retrospective study. 40 operated patients between January 1971 and January 2001 have been included. 27 patients (67.5%) had a borderline tumour, 10 (25%) a non-epithelial tumour (germinal or stromal) and 3 (7.5%) an epithelial invasive carcinoma. All these patients have benefited from a conservative surgical management of fertility. The Assisted Reproductive Technologies were simple stimulation for 5 women and IVF for the 35 others. The effectiveness and the risks of Assisted Reproductive Technologies have been estimated respectively by the number of pregnancies obtained and the recurrence rates.


RESULTS
With a global follow-up of 372 months (January 1971: date of the primary surgical procedure--June 2002: closing of the study), 17 patients have obtained 17 pregnancies with the Assisted Reproductive Technologies, rate of 42.5% (17/40): 1 spontaneous abortion, 16 delivery with 23 children (triple pregnancies and 3 twin pregnancies). 3 patients treated for a borderline tumour have had a recurrence after induction of ovulation. Among the 40 patients, no one presented an evolved disease at the last news. The patients who had a recurrence had a delay to begin the Assisted Reproductive Technologies significantly lower than the patients who had no recurrence.


CONCLUSIONS
The assisted reproductive technologies for patients who had been treated for a borderline or invasive ovarian tumour, and who were infertile in spite of conservative management, have allowed 42.5% of these women to obtain a pregnancy and does not seem to increase significantly the risk of recurrence.
Fortin
A
A
Service de gynécologie-obstétrique, maternité Aline-de-Crépy, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
Hazout
A
A
Thoury
A
A
Alvès
K
K
Bats
A-S
AS
Dhainaut
C
C
Madelenat
P
P
D000328:Adult; D002277:Carcinoma / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005307:Fertilization in Vitro / Q000009:adverse effects; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology* / Q000517:prevention & control; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000601:surgery*; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000517:prevention & control; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects; D012189:Retrospective Studies; D018570:Risk Assessment