SANTA MONICA, CALIF. — Fertility drugs can be used safely in patients who experience infertility after conservative management of early-stage borderline ovarian tumors, according to a poster presentation by Dr. Anne Fortin at the biennial meeting of the International Gynecologic Cancer Society.
The use of fertility drugs is theoretically contraindicated in patients treated for ovarian malignancies, but only 4 of 30 patients (13%) developed a recurrence after fertility treatment.
Generally the recurrence rate is 15% for stage I borderline ovarian tumors and 20% for stage II-IV tumors, according to published sources (www.emedicine.com/med/topic3233.htm
Thirteen of the patients (43%) became pregnant. Among those were one miscarriage, one premature delivery at 20 weeks of amenorrhea, and 11 normal pregnancies, including one set of twins and one set of triplets.
In the multicenter, retrospective study, the investigators, from Universitaire Bichat, Paris, and Institut Gustav Roussy, Villejuif, France, identified 30 women from 27 centers who had conservative surgery for borderline ovarian tumors that was aimed at preserving subsequent fertility.
To be included in the study, patients had either simple ovarian stimulation with clomiphene citrate or in vitro fertilization with hyperstimulation.
Eight of the patients underwent cystectomy, 17 underwent oophorectomy or salpingo-oophorectomy, and 5 underwent salpingo-oophorectomy and contralateral cystectomy. After histology it was found that 23 of the patients had a serous tumor and 7 had a mucinous tumor or a mixed tumor. Twenty of the patients had stage I disease, four had stage II disease, four had stage III disease, and two patients were not staged.
Twenty-five of the patients were treated for infertility; the other five were stimulated at relapse and were referred to as “emergency cases.” Of the patients with infertility, the median period of infertility before treatment was 20 months.
Three of the five patients requiring emergency treatment and 10 of the 25 patients treated for infertility became pregnant.
The median follow-up after conservative treatment of the ovarian tumor was 93 months, and the median follow-up after infertility treatment was 42 months.
Of the four patients with recurrences, two were disease free for 12 months, one for 40 months, and one for 84 months.
The authors concluded that fertility drugs may be safely used in patients who were infertile after conservative management of an early-stage borderline ovarian tumor that has been carefully followed up. They wrote that the number of patients with advanced-stage disease was too small to draw conclusions regarding the effect of fertility drugs.