Fertility preservation in ovarian tumors
If you are a woman of reproductive age and have recently been diagnosed with an ovarian tumor, DON’T PANIC! We are here to help you.
Unlike other malignancies, things are a little more complicated here, as it is the egg-producing organ that is affected. Often the treatment of ovarian tumors would involve their surgical removal and subsequent chemotherapy.
In cases where the patient has no preserved eggs or embryos, the surgical removal of both ovaries makes it impossible to give birth to a child with her genetic material. Chemotherapy by itself causes damage to ovarian function (hormone and egg production).
Therefore global recommendations are unanimous – all women of reproductive age with cancer, regardless of its type and stage, should consult with a reproductive specialist before starting any treatment!
Due to the complex structure of the ovary, ovary tumors can be truly diverse. Accurate definition of the disease stage and histological diagnosis are essential, as the possibilities of preserving reproductive capacity vary considerably between different diseases and disease stages.
In recent years fertility-sparing surgery (removal only of the affected ovary and tube while preserving the uterus and at least part of the unaffected ovary) has become standard practice for certain types of tumors.
In general, ovarian tumors classify as benign, borderline malignancy, and malignant.
In benign tumors, as well as in those with borderline malignancy at an early stage, preservation of the apparently intact ovary and uterus is not just possible; it is standard practice. In these tumors, postoperative chemotherapy is not indicated, and therefore stimulation and egg preservation are not necessary.
Studies have shown that patients with an early borderline malignancy tumor experience spontaneous pregnancy in 54% of cases after surgery with a low risk of recurrence. In those with an advanced one though, the success rate is slightly lower at 34%.
Malignant ovarian tumors are divided into different groups depending on the cells that they originate from.
Germinative-cell tumors of the ovary account for about 5% of all ovarian neoplasms but occur almost exclusively among women of reproductive age. They have a very good prognosis even in their more advanced stages.
Standard practice in their treatment involves fertility-sparing surgery with preservation of the unaffected ovary and uterus. The administration of postoperative chemotherapy is often necessary, so controlled ovarian stimulation and preservation of eggs or embryos is recommended before its initiation.
Sex cord-stromal tumors account for about 7% of all ovarian neoplasms and again occur more frequently among women of reproductive age.
The two most common subtypes are the granulose cell tumor and the Sertoli-Leydig tumor. Again, fertility-sparing surgery is possible in the disease early stages,
Epithelial ovarian tumors are the most common ones, representing a very heterogeneous group. In the majority of cases the standard treatment involves removal of both ovaries and the uterus, and postoperative chemotherapy.
If certain indications are strictly met (stage IA and selected cases of stage IC1, low-grade serous, endometrioid or mucinous carcinomas), fertility-sparing surgery is possible, and our hospital can provide it.
Frequently asked questions and common situations you may run into
When radical surgery is proposed to you (removal of the ovaries and uterus), this should be discussed with a fertility preservation specialist. Very often radical decisions by cancer surgeons are for your own good, but this is not always the only option.
Sometimes uterus removal is required. If this were to happen, fertility sparing is a big question mark. Seeking surrogacy abroad provides an alternative option.
At age 34+, don't be discouraged to ask about egg freezing options! Chances are lower but are still there.
If you carry a gene mutation in one of the BRCA genes, you are probably facing a dilemma about what to do.
Controlled ovarian stimulation and egg freezing before deciding on prophylactic surgical removal of the ovaries is a good option and you can proceed with it after consultation with an oncologist and fertility sparing specialist.
Caution! Carriers of this mutation have poorer ovarian reserve and respond poorly to stimulation, therefore options for multiple stimulations prior to surgery should be discussed in order to have enough eggs.
You should also always seek a second opinion about fertility sparing before having surgery!
A lot of decisions are made during surgery and all options should be discussed beforehand. We are here for you. Get in touch with us, and we will provide advice immediately!
In conclusion, modern therapeutic options in oncology give a real chance for curing the majority of patients with ovarian tumors, so preserving your fertility gives you a future.
Fertility preservation options
In current practice, the following procedures are used to preserve fertility in cases with ovarian tumors – fertility-sparing surgery, egg/embryo freezing, ovarian tissue freezing, and attempted ovarian function preservation during chemotherapy.
|Fertility preservation options|| |
Frequency of application and success rate of the approach
Limitations of the approach in relation to cancer characteristics
|Fertility-sparing surgery|| |
|Fertility-sparing surgery is a modern approach to the treatment of some early-stage ovarian tumors, wherein the affected ovary and tube are removed, but the uterus and at least part of the other ovary remain.|
|Egg freezing||★★★|| |
Egg freezing with prior stimulation is the best option for some ovarian tumors. Of course, the eggs could be fertilized and frozen as embryos, and this should be discussed with the reproductive specialist you are planning the procedure with. For hormone-dependent tumors, we use protocols that include estradiol hormone lowering medications; we use such medication in stimulation protocols for women with breast cancer.
The puncture of a stimulated ovary in cases with aggressive forms of cancer in the previously removed engaged ovary is specific. Laparoscopy is used for surgical access laparoscopy; thus directly observing the ovary, a dissemination of the disease is avoided. In very aggressive tumors it is also possible to stimulate the healthy ovary, remove it surgically and the eggs can then be collected outside the woman's body. This way there is no danger of cancer cells spreading in the body. These surgeries are performed by a trained and skilled team of specialists in our hospital. When time is running out and the process is already at an advanced stage, removing the ovary without stimulation and collecting immature eggs to mature in an incubator is also an approach we could apply, but it has lower success rate.
Ovarian tissue freezing
|★★||Freezing tissue from the healthy ovary is used in cases where we do not have enough time before starting treatment. However, this requires laparoscopic surgery, and reimplantation of ovarian tissue carries a potential risk of recurrence, so we try to avoid this option.|
|Ovarian function preservation during chemotherapy||★|| |
Many drugs claim partial success in protecting the ovary from chemotherapy. After consulting us, what we can offer is various therapeutic combinations during the treatment period; relying on this option alone, however, is rarely a guarantee for success. However, if you are unable to consult with us and are starting therapy – take melatonin 4 mg per day; it has no adverse effects, it is rather useful, and may help you.
Always seek an alternative and a consultation on preserving reproductive cells first!
★★★ - most commonly used approach, highest success rate ★★ - less frequently used approach, lower success rate ★ - rarely used approach