Ovarian tumours can be quite diverse in nature and have varying prognosis; in the repro­duct­ive age the so-called bor­der­line tumours account for a pro­por­tion of 31%, epi­theli­al tumours for 50%, and malignant germ cell tumours for of 19%.

In case of a benign ovarian tumour the removal should be performed tissue sparing. In case of a malignant tumour, espe­cially in young women with a current or future desire to have children, it is difficult to decide how aggress­ive the treatment should be to achieve the best outcome. However, in general all malignant ovarian tumours require the removal of at least the affected ovary. This of course reduces the amount of oocytes available to achieve a pregnancy later. In addition, tissue samples are taken from different parts of the abdomen during surgery in order to detect a possible spread of the disease.

Depending on the type of ovarian tumour, its aggress­ive­ness and possible spread to other organs it might be recom­men­ded to addi­tion­ally remove the second ovary, possibly also the uterus, fallopian tubes and other organs such as the appendix. Depending on the extent of the surgery a sub­sequent pregnancy may not be possible anymore. In certain situ­ations, chemo­ther­apy is also recom­men­ded for treatment.

Fertility pre­ser­va­tion is safe but only useful in younger women (<40 years of age) with a uni­lat­er­al ovarian involve­ment (FIGO IA G1) showing ovarian cancer or a bor­der­line ovarian tumour.

The cryo­p­reser­va­tion of ovarian tissue is currently not recom­men­ded due to the concern of a recol­on­iz­a­tion of tumour cells in case of tissue trans­plant­a­tion later on. To perform a hormonal stim­u­la­tion for retriev­ing oocytes seems to be possible in certain cases; however, several treatment cycles may be required to freeze a reas­on­able number of oocytes. Moreover, whether this procedure leads to an increased risk of recur­rence is unknown. If the treatment includes a chemo­ther­apy GnRH agonist admin­is­tra­tion may be considered.

One way to facil­it­ate the patient’s decision after the con­sulta­tion regarding fertility-pre­serving measures is the “Decision Aid” linked here.
This digital decision aid has been developed by psy­cho­lo­gists, psy­cho­ther­ap­ists and repro­duct­ive phys­i­cians and might help in an indi­vidu­al situation.

Detailed inform­a­tion and a bib­li­o­graphy can be found in the Fer­ti­PRO­TEKT booklet “Indika­tion und Durch­führung fer­til­ität­s­pro­tekt­iver Maßnahmen bei onko­lo­gis­chen und nicht-onko­lo­gis­chen Erkrankun­gen”, 2nd revised edition 2020, which was written by members of the Fer­ti­PRO­TEKT Netzwerk e.V. and is available free of charge (in German).

(Chap. 2.4)

An english version can be bought: Fertility Pre­ser­va­tion in Onco­lo­gic­al and Non-Onco­lo­gic­al Diseases a practical guide by Michael von Wolff & Frank Nawroth ISBN 978–3‑030–47567‑3 from Springer.com
Part II page 65ff