Fertility preservation in the management of epithelial ovarian tumors

Conservative management of at least part of one ovary and uterus can be proposed in patients with early-stage borderline ovarian tumor, in order to preserve fertility-potential. Such management could be also proposed in selected cases of advanced stage (patients with non-invasive implants but with complete peritoneal resection). Spontaneous fertility could be observed following such conservative management. In the presence of persistent infertility, an ovarian induction or in vitro procedures could be proposed in patients with an early-stage disease, though the number of attempts must be limited. A removal of the preserved ovary after completion of the pregnancy(ies) is not necessary if patients agree to be followed-up carefully. In patients with epithelial ovarian cancer, it seems that conservative management could be safely performed in women with: unilateral tumor (stage IA), grade 1 (and 2?), adequate staging surgery, and careful follow-up. Results of such management in patients with stage IC disease should be evaluated. But such conservative surgery should not be performed in patients with tumor stage >I and/or grade 3. Removal of the preserved ovary should be performed after completion of pregnancy(ies), in order to reduce the risk of ovarian recurrence.