Preservation of the human ovary

Abstract

Study 1a assessed oncological safety of fertility-sparing surgery (FSS) in 172 women with borderline ovarian tumours (BOTs). FSS was performed in 52.3% of cases and associated with higher recurrence than non-FSS (25.6% vs 7.7%). However, no invasive recurrences occurred following FSS, whereas all recurrences after radical surgery were invasive low-grade serous carcinomas. Ultrasound-guided ovarian wedge resection (UGOWR) was introduced as a novel FSS technique, showing comparable recurrence rates to established approaches, with postoperative ultrasound surveillance enabling early detection. Study 1b compared BOT recurrence in women pursuing spontaneous pregnancy (SP) or fertility treatment (FT) following FSS versus non-exposed women. Recurrence risk did not differ significantly overall (22.2% vs 20%). While FT combined with successful SP was associated with increased recurrence risk, all recurrences were non-invasive, supporting the oncological safety of fertility treatment. Study 2 surveyed 415 UK healthcare professionals and identified major deficits in fertility preservation (FP) education: 87% had no formal training, 39.5% never discussed FP with patients, and over half lacked counselling confidence, demonstrating system-wide barriers to effective FP provision. Study 3’s randomized trial comparing laparoscopic cystectomy with ultrasound-guided ovarian cystectomy (UGLOC) found no significant differences in postoperative ovarian reserve (AMH, AFC) at six months, though UGLOC resulted in less excised ovarian tissue, suggesting potential benefit for women with diminished baseline reserve. Study 4a surveyed 5,482 UK women and revealed pervasive misinformation on fertility decline, miscarriage risk, elective oocyte cryopreservation (EOC) timing and costs. Study 4b evaluated outcomes from EOC cycles: live birth occurred in 26.8% of thaw cycles, with no livebirths demonstrated among women ≥40. Study 5a demonstrated that reduced ovarian reserve (low AMH/AFC) significantly increases miscarriage risk, particularly in women under 35. Study 5b found that blastocyst PGT-A modestly improves live birth and implantation rates while reducing miscarriage compared with morphology alone, although further validation is required.Open Acces