Controlled Ovarian Stimulation After Fertility-Sparing Surgery for Borderline Ovarian Tumors: An Exploratory Cohort Study on Recurrence and Reproductive Outcomes
by
, , , , , , , and
Sofia Thiella
1, 
Giacomo Corrado
2,*
,
Paola Villa
2,3,4,
Inge Peters
2
,
Diana Giannarelli
5,
Rossella Letizia Mancusi
5,
Tina Pasciuto
3,6
,
Lucrezia Massaro
1,
Maria Luisa Di Pietro
1,3,
Maria Lucia Specchia
3 and
Anna Fagotti
2,7 1
Centre for Research and Studies on Reproductive Health, Catholic University of the Sacred Heart, 00168 Rome, Italy
2
Gynaecologic Oncology Unit, Department of Woman’s and Child Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00167 Rome, Italy
3
Department of Life Sciences and Public Health Section of Hygiene, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00167 Rome, Italy
4
Department of Woman’s and Child Health and Public Health Sciences, Quality of Life, Integrated Therapies and Oncology Follow-Up, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, 00167 Rome, Italy
5
Epidemiology and Biostatistics Research Core Facility Gemelli Science and Technology Park (G-STeP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00167 Rome, Italy
6
Data Collection Research Core Facility Gemelli Science and Technology Park (G-SteP), Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00167 Rome, Italy
7
Faculty of Medicine and Surgery, Catholic University of the Sacred Heart, 00168 Rome, Italy
*
Author to whom correspondence should be addressed.
Curr. Oncol. 2026, 33(4), 206; https://doi.org/10.3390/curroncol33040206
Submission received: 5 February 2026
/
Revised: 24 March 2026
/
Accepted: 1 April 2026
/
Published: 3 April 2026
(This article belongs to the Section Gynecologic Oncology)
Simple Summary
Women with borderline ovarian tumors are often young and wish to preserve their fertility. Fertility-sparing surgery allows the uterus and part of the ovary to be maintained, but concerns remain about whether ovarian stimulation to freeze eggs after surgery could increase the risk of tumor recurrence. This study evaluated women who underwent fertility-sparing surgery for borderline ovarian tumors, comparing those who later had ovarian stimulation for egg freezing with those who did not. Over a median follow-up of nearly three years, ovarian stimulation was not associated with a higher risk of tumor recurrence. Importantly, almost one quarter of women achieved at least one pregnancy, mostly without assisted reproductive techniques. These findings suggest that ovarian stimulation for fertility preservation after fertility-sparing surgery may be a feasible option for women with borderline ovarian tumors. Larger studies are needed to confirm these results and to guide clinical decision-making and counseling in oncofertility care.
Abstract
Borderline ovarian tumors often affect women of reproductive age for whom fertility preservation may be a major concern. While fertility-sparing surgery is widely accepted, the safety of controlled ovarian stimulation for oocyte cryopreservation after surgery remains uncertain due to potential recurrence risk. This retrospective single-center cohort study explored the association between controlled ovarian stimulation following fertility-sparing surgery and both recurrence risk and reproductive outcomes. Patients treated between January 2011 and June 2024 were included. Baseline characteristics, surgical details, and reproductive outcomes were compared using non-parametric and exact tests. Progression-free survival was assessed with Kaplan–Meier estimates and Cox proportional hazards models, modeling stimulation as a time-dependent covariate, and using a 10-month landmark analysis to account for immortal time bias. Of 45 included patients, 19 underwent ovarian stimulation after surgery, with a median interval of 9.9 months to stimulation. Median follow-up was 34.4 months. Recurrence occurred in 21.1% of stimulated patients versus 38.5% of non-stimulated patients (p = 0.338). After adjustment for time-dependent exposure, ovarian stimulation was not associated with increased recurrence risk (HR 0.95, 95% CI 0.22–4.09; p = 0.944). Eleven patients (24.4%) achieved at least one pregnancy, 81.8% of which were spontaneous. Controlled ovarian stimulation for oocyte cryopreservation after fertility-sparing surgery for borderline ovarian tumors did not show an increased recurrence risk, although larger studies are needed.
