title: Fertility preservation in women with borderline ovarian tumours.
abstract: Borderline ovarian tumours (BOT) may occur in young women and have an excellent survival rate. Therefore, there is the obligation to put emphasis on fertility preservation in affected women. On the other hand, it has also been underlined that the disease should be managed with caution because these tumours can relapse and, albeit rare, malignant transformation can also occur. Unfortunately, evidence on fertility preservation in women with BOT is scanty. In this opinion paper, we tried to draw some clinical indications based on the few available studies on the clinical management of BOT and their possible relation with controlled ovarian hyper-stimulation (COH). We ultimately came to the following conclusions: (1) Fertility counselling should become an integral part of the clinical management of women with BOT. Conservative management without pre-surgical counselling may expose women without reasonable chances of future conceptions to undue risks. (2) Despite some epidemiological concerns on the possible relation between COH and BOT, the conservative surgical treatment should be associated to oocyte cryopreservation considering the high risk of recurrence of the disease. (3) Letrozole during COH should be considered to temper the theoretical risk of increased recurrences. (4) Pregnancy should not be delayed in women at low-moderate risk of recurrences. Fertility preservation may be avoided in these women provided that they start active pregnancy seeking early. (5) Albeit experimental, oocytes retrieval from affected ovaries removed at the time of surgery can be considered. Conversely, ovarian cortex cryopreservation is not justified given the possible risks of malignant reseeding.
authors.affiliation: Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. Electronic address: mangili.giorgia@hsr.it.
authors.forename: Giorgia
authors.initials: G
authors.lastname: Mangili
authors.affiliation: Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Manfredo Fanti 6, 20122 Milan, Italy. Electronic address: dadosomigliana@yahoo.it.
authors.forename: Edgardo
authors.initials: E
authors.lastname: Somigliana
authors.affiliation: Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. Electronic address: giorgione.veronica@hsr.it.
authors.forename: Veronica
authors.initials: V
authors.lastname: Giorgione
authors.affiliation: Gynaecologic Oncology Unit, Fondazione National Cancer Institute, Via Venezian 1, 20133 Milan, Italy. Electronic address: fabio.martinelli@istitutotumori.mi.it.
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Infertility Unit, Fondazione Ca' Granda, Ospedale Maggiore Policlinico, Via Manfredo Fanti 6, 20122 Milan, Italy. Electronic address: francesca.filippi@gmail.com.
authors.forename: Francesca
authors.initials: F
authors.lastname: Filippi
authors.affiliation: Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141 Milan, Italy. Electronic address: mariacristina.petrella@gmail.com.
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Petrella
authors.affiliation: Department of Obstetrics and Gynaecology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy. Electronic address: candiani.massimo@hsr.it.
authors.forename: Massimo
authors.initials: M
authors.lastname: Candiani
authors.affiliation: Fertility and Procreation Unit, Division of Gynaecologic Oncology, European Institute of Oncology, Via Giuseppe Ripamonti 435, 20141 Milan, Italy. Electronic address: fedro.peccatori@ieo.it.
authors.forename: Fedro
authors.initials: F
authors.lastname: Peccatori
mesh_terms: D000072700:Conservative Treatment; D015925:Cryopreservation; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000517:prevention & control*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009865:Oocytes; D059351:Organ Sparing Treatments; D010051:Ovarian Neoplasms / Q000628:therapy*; D010052:Ovariectomy; D010062:Ovulation Induction / Q000009:adverse effects / Q000379:methods*; D012306:Risk
keywords: Borderline ovarian tumours; Fertility preservation; Infertility; Oocyte cryopreservation; Ovulation induction