J Korean Med Sci.  2007 Sep;22(Suppl):S134-S138. 10.3346/jkms.2007.22.S.S134.

Outcomes of Controlled Ovarian Hyperstimulation/In Vitro Fertilization for Infertile Patients with Borderline Ovarian Tumor after Conservative Treatment

• Park CW
• Yang KM
• Kim HO
• Hong SR
• Kim TJ
• Lim KT
• Lee KH
• Kang IS

• KMID: 1785802
• DOI: http://doi.org/10.3346/jkms.2007.22.S.S134

Abstract

To evaluate the outcomes of controlled ovarian hyperstimulation (COH)-in vitro fertilization (IVF) such as clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) for infertile patients with borderline ovarian tumor (BOT) after conservative treatment, 10 IVF cycles in five patients from January 1999 to July 2005 were analyzed. At the time of diagnosis with BOT, the mean age of patients was 30.0 yr (range, 22-40). For 8 cycles out of 10 attempted IVF cycles, except for 2 cancellation cycles, the mean number of oocytes retrieved was 5.6 (range, 2-16) with a mean fertilization rate of 74.4%. The CPR, IR, and LBR were 50.0% (4/8 cycles), 31.6% (6/19) and 50.0% (4/8 cycles) respectively. The mean follow-up period after COH-IVF initiation was 29.6 (range, 14-61) months. A gynecological oncologist followed all patients every 3 months during the first year and every 6 months thereafter. There was no recurrence during the follow-up period. Our results suggest that COH-IVF may be acceptable for infertile patients with BOT, especially in patients with early-stage BOT after conservative treatment.

Keyword

In Vitro Fertilization; Borderline Ovarian Tumor; Conservative Treatment

MeSH Terms

Adult
Embryo Transfer
Female
Fertilization in Vitro
Humans
Infertility, Female/*complications/*therapy
Ovarian Neoplasms/*complications/pathology/*surgery
Ovulation Induction/methods
Pregnancy
Pregnancy Complications, Neoplastic
Prognosis
Treatment Outcome

Figure

• 

  Fig. 1 (A) Mucinous borderline tumor, endocervix-like type. It is composed of broad papillae covered with proliferating mucinous eithelium. Proliferating tumor cells show tufting with mild to moderate cytologic atypia and neutrophils in their cytoplasm (inset). (B) Serous borderline tumor. This tumor is composed of numerous papillae that are covered with serous epithelium showing proliferation with tufting and cytologic atypia (left upper). This case reveals a few microinvasive foci (left lower) (H&E stain).

Reference

1. Trope CG, Kristensen G, Makar A. Surgery for borderline tumor of the ovary. Semin Surg Oncol. 2000. 19:69–75.

2. Kurman RJ, Trimble CL. The behavior of serous tumors of low malignant potential: are they ever malignant? Int J Gynecol Pathol. 1993. 12:120–127.

3. Casey AC, Bell DA, Lage JM, Fuller AF, Nikrui N, Rice LW. Epithelial ovarian tumors of borderline malignancy: long-term follow-up. Gynecol Oncol. 1993. 50:316–322.

4. Ness RB, Cramer DW, Goodman MT, Kjaer SK, Mallin K, Mosgaard BJ, Purdie DM, Risch HA, Vergona R, Wu AH. Infertility, fertility drugs, and ovarian cancer: a pooled analysis of case-control studies. Am J Epidemiol. 2002. 155:217–224.

5. Shushan A, Paltiel O, Iscovich J, Elchalal U, Peretz T, Schenker JG. Human menopausal gonadotropin and the risk of epithelial ovarian cancer. Fertil Steril. 1996. 65:13–18.

6. Harris R, Whittemore AS, Itnyre J. Collaborative Ovarian Cancer Group. Characteristics relating to ovarian cancer risk: collaborative analysis of 12 US case-control studies. III. Epithelial tumors of low malignant potential in white women. Am J Epidemiol. 1992. 136:1204–1211.

7. Parazzini F, Negri E, La Vecchia C, Moroni S, Polatti A, Chiaffarino F. Treatment for fertility and risk of ovarian tumors of borderline malignancy. Gynecol Oncol. 1998. 68:226–228.

8. Shushan A, Paltiel O, Schenker JG. Induction of ovulation and borderline ovarian cancer--the hormonal connection? Eur J Obstet Gynecol Reprod Biol. 1999. 85:71–74.

9. Abu-Jawdeh GM, Jacobs TW, Niloff J, Cannistra SA. Estrogen receptor expression is a common feature of ovarian borderline tumors. Gynecol Oncol. 1996. 60:301–307.

10. Madelenat P, Meneux E, Fernandez H, Uzan S, Antoine JM. Place de l'assistance à la procréation après traitement conservateur d'une tumeur ovarienne: enquête multicentrique francaise. In : 10eme Congrès de la Société Francaise d'Oncologie Gynécologique; 5-6 November 1999; Poitiers. France.

11. Fasouliotis SJ, Davis O, Schattman G, Spandorfer SD, Kligman I, Rosenwaks Z. Safety and efficacy of infertility treatment after conservative management of borderline ovarian tumors: a preliminary report. Fertil Steril. 2004. 82:568–572.

12. Nijman HW, Burger CW, Baak JP, Schats R, Vermorken JB, Kenemans P. Borderline malignancy of the ovary and controlled hyperstimulation, a report of 2 cases. Eur J Cancer. 1992. 28:1971–1973.

13. Mantzavinos T, Kanakas N, Genatas C, Papadias K, Zourlas PA. Five years' follow-up in two patients with borderline tumours of the ovary hyperstimulated by gonadotrophin therapy for in-vitro fertilization. Hum Reprod. 1994. 9:2032–2033.

14. Hoffman JS, Laird L, Benadiva C, Dreiss R. In vitro fertilization following conservative management of stage 3 serous borderline tumor of the ovary. Gynecol Oncol. 1999. 74:515–518.

15. Rossing MA, Daling JR, Weiss NS, Moore DE, Self SG. Ovarian tumors in a cohort of infertile women. N Engl J Med. 1994. 331:771–776.

16. Beiner ME, Gotlieb WH, Davidson B, Kopolovic J, Ben-Baruch G. Infertility treatment after conservative management of borderline ovarian tumors. Cancer. 2001. 92:320–325.

17. Seidman JD, Kurman RJ. Subclassification of serous borderline tumors of the ovary into benign and malignant types. A clinicopathologic study of 65 advanced stage cases. Am J Surg Pathol. 1996. 20:1331–1345.

18. Camatte S, Morice P, Pautier P, Atallah D, Duvillard P, Castaigne D. Fertility results after conservative treatment of advanced stage serous borderline tumour of the ovary. BJOG. 2002. 109:376–380.

19. Attar E, Berkman S, Topuz S, Baysal B, Akhan S, Chambers JT. Evolutive peritoneal disease after conservative management and the use of infertility drugs in a patient with stage IIIC borderline micropapillary serous carcinoma (MPSC) of the ovary: case report. Hum Reprod. 2004. 19:1472–1475.

20. Morice P, Camatte S, Wickart-Poque F, Rouzier R, Pautier P, Pomel C, Lhommé C, Haie-Meder C, Duvillard P, Castaigne D. Conservative management of malignant and borderline ovarian tumor. Bull Cancer. 2002. 89:1019–1026.

21. Donnez J, Munschke A, Berliere M, Pirard C, Jadoul P, Smets M. Safety of conservative management and fertility outcome in women with borderline tumors of the ovary. Fertil Steril. 2003. 79:1216–1221.

22. Seracchioli R, Venturoli S, Colombo FM, Govoni F, Missiroli S, Bagnoli A. Fertility and tumor recurrence rate after conservative laparoscopic management of young women with early-stage borderline ovarian tumors. Fertil Steril. 2001. 76:999–1004.

23. Morris RT, Gershenson DM, Silva EG, Follen M, Morris M, Wharton JT. Outcome and reproductive function after conservative surgery for borderline ovarian tumors. Obstet Gynecol. 2000. 95:541–547.