LAUSR

Borderline ovarian tumors (BOT) account for 10–20% of all ovarian epithelial tumors, with one-third of cases diagnosed under the age of 40 [1]. Fertility-sparing surgery (FSS) can be offered to patients who wish to spare their reproductive potential, even if the overall risk of recurrence after FSS is higher (0–25%) than after bilateral salpingo-oophorectomy (0–5%) [2, 3]. The management of patients who recur after FSS is challenging. Although a second FSS can be offered [4, 5], repeated surgery may reduce healthy ovarian parenchyma, increasing the risk of infertility [6]. Moreover, the occurrence of postoperative adhesions might interfere with fallopian tube function [7]. Thus, for a patient undergoing FSS and interested in having a pregnancy, the best option is to achieve pregnancy through spontaneous conception immediately after first surgery, acknowledging the higher recurrence rate during the first 2 years [8–10] and that pregnancy does not increase this risk [11–14]. In situations involving a personal history of infertility or when reproduction is not desired by patients yet, the most appropriate plan B is to rely on assisted reproductive techniques (ARTs), with oocyte harvesting and cryopreservation after FSS [15]. In this issue of Journal of Assisted Reproduction and Genetics, Filippi and colleagues report their experience in harvesting and cryopreserving oocytes before surgery as a novel strategy of fertility preservation for patients who had an ovarian relapse after FSS [16]. They describe two successful cases that underwent gonadotrophin administration with concomitant letrozole, apparently without an increase in tumor volume and conclude that “oocyte cryopreservation at the time of recurrence of BOT is feasible and may be considered in the decision-making process with the patients.” Authors should be commended for exploring different options of fertility preservation in this challenging setting but several critical questions should be answered: