精准医学杂志 (Oct 2023)

A REPORT OF 4 CASES OF ASSISTED REPRODUCTION AFTER FERTILITY-SPARING SURGERY IN PATIENTS WITH BORDERLINE OVARIAN TUMORS AND LITERATURE REVIEW

  • GE Yanxin, LIU Hui, XIANG Yanjie

DOI
https://doi.org/10.13362/j.jpmed.202305005
Journal volume & issue
Vol. 38, no. 5
pp. 396 – 399

Abstract

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Objective To explore the safety of fertility-sparing surgery and the selection of ovulation induction protocols in patients with early-stage borderline ovarian tumors (BOTs). Methods Clinical data were collected from four patients with early-stage BOTs who underwent fertility-sparing surgery and later sought treatment for infertility with assisted reproduction and successfully delivered in Xinhua Hospital Affiliated to School of Medicine in Shanghai Jiao Tong University from January 2015 to December 2021. The postoperative follow-up and assisted reproduction of the patients were reviewed in combination with the literature. The estrogen levels of patients on HCG day were compared between antagonist protocol, agonist protocol, and letrozole mild stimulation protocol. Results Two of the four patients with early-stage BOTs relapsed after fertility-sparing surgery. The pa-thological type of relapse was BOTs without malignant transformation. No recurrence was observed during follow-up after the se-cond operation. All four patients underwent assisted reproduction and achieved delivery. One of the patients who experienced relapse underwent oocyte retrieval before the second surgery and achieved pregnancy through frozen embryo transplantation after the surgery. Three out of four patients used letrozole mild stimulation protocol (two of them achieved pregnancy, while the other patient switched to agonist protocol after failing to retrieve oocytes and subsequently became pregnant). The remaining patient used anta-gonist protocol and achieved pregnancy. Compared with the antagonist and agonist protocols, letrozole mild stimulation protocol had the lowest serum estrogen level on the HCG day. Conclusion Fertility-sparing surgery for patients with early-stage BOTs is safe and feasible. Oocyte retrieval can be considered in case of recurrence before reoperation. Letrozole mild stimulation protocol provides a relatively safe option with minimal adverse effects on the ovaries.

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