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Challenge: ART in a patient with a previous borderline ovarian tumor (BOT).

Background:

 BOTs account for 10–20% of all ovarian tumors; approximately one‐third of these occur in women of reproductive age.

 They have low malignancy potential.

 Preservation of fertility is an important issue in the management of BOTs.

 BOTs are bilateral in 25–50% of cases.

 Fertility‐sparing surgery involves preservation of at least part of one ovary, and the uterus.

 The recurrence risk (after conservative fertility‐sparing surgery) is reported to be around 10%. In women who have gonadotropin stimulation, the recurrence rate may be doubled, although causation has not been firmly established.

 Almost all recurrences are again borderline ovarian tumors, with excellent survival prospects.

Management options:

 Liaise with the gynecologic oncology team.

 Pelvic ultrasound to rule out ovarian cysts before fertility treatment.

 Serum marker: CA125

 Aim to reduce the number of ART cycles as ovarian stimulation may increase recurrence.

 Once fertility treatment is completed, the oncology team may consider “completion surgery,” particularly in women who had cystectomy (as opposed to oophorectomy), advanced stage disease, mucinous tumors and any evidence of peritoneal implants.