title: Fertility and borderline ovarian tumor: a systematic review of conservative management, risk of recurrence and alternative options.
abstract: BACKGROUND
  The aim of this systematic review was to evaluate the fertility outcome after borderline ovarian tumor (BOT) management and the results of conservative management, risk of recurrence and alternative options.
  
  
  METHODS
  The search strategy was based on relevant terms concerning BOT using Medline and the Central Cochrane Library. Both early and advanced stages of serous and mucinous BOT were included, but not rare entities such as endometrioid, Brenner or clear-cell BOT because of their low incidence. We considered all articles-case reports, original studies, meta-analyses and reviews-in English and French.
  
  
  RESULTS
  Overall, 230 articles were screened of which 120 were retained for review. Most pregnancies were spontaneous but some data were obtained from studies analyzing the contribution of assisted reproductive technology (ART). However, not all studies differentiated spontaneous pregnancy from those obtained after fertility treatment including ovulation induction, intrauterine insemination and IVF. Conservative management of early stage BOT resulted in a pooled estimate for spontaneous pregnancy rate of 54% with a low risk of lethal recurrence (pooled estimate: 0.5%). In patients with advanced stage BOT, the spontaneous pregnancy rates was lower (34% in the single series reporting pregnancy rate in this context) and the risk of lethal recurrence increased (pooled estimate: 2%).
  
  
  CONCLUSIONS
  This systematic review underlines that fertility subsequent to treatment of BOT depends mainly on histology and initial staging to distinguish early from advanced stages. In patients with advanced stage BOT, several alternative options to conservative management are available to allow patients to conceive without compromising their prognosis.
authors.affiliation: Department of Obstetrics and Gynaecology, Hôpital Tenon, Paris, France. emile.darai@tnn.aphp.fr
authors.forename: Emile
authors.initials: E
authors.lastname: Daraï
authors.forename: Raffaèle
authors.initials: R
authors.lastname: Fauvet
authors.forename: Catherine
authors.initials: C
authors.lastname: Uzan
authors.forename: Sébastien
authors.initials: S
authors.lastname: Gouy
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
mesh_terms: D005260:Female; D005298:Fertility; D006801:Humans; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D010051:Ovarian Neoplasms / Q000628:therapy*; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000628:therapy*; D011256:Pregnancy Outcome; D018873:Pregnancy Rate; D027724:Reproductive Techniques, Assisted