Understanding the low adherence to fertility preservation program in women treated for borderline ovarian tumors

Borderline ovarian tumors (BOT) account for 10-20 % of malignant ovarian tumors affecting up to one third of young patients. Therefore, fertility sparing surgery (FSS) has gained attention followed by fertility preservation program (FPP) mainly using controlled ovarian stimulation (COS). However, the determinants to accept or to refuse fertility FPP remain unclear raising the issue on shared decision making.

From January 2021 to November 2024, a retrospective analysis from a prospective database of patients with BOT eligible for FPP (patients between 18-, and 43-years-old) were identified and interviewed to evaluate the determinants to refuse FPP. For patients accepting FPP, results of COS were analyzed.

Among which 66 patients with BOT undergoing FSS, 29 were eligible for FPP, among them 18 refused the procedure. The main determinants to refuse the FPP were an age >35-years-old, the futility of FPP in 50 % of case, the renouncement to future pregnancy in one-third of cases, and the stress of recurrence (two patients). One patient refused to answer. Among the 18 patients refusing FPP, five became pregnant spontaneously. For the 11 accepting the FPP with COS, the median delay between FSS and COS was 6 months (3-13 months), nine underwent 1 COS cycle and the two patients underwent 2 COS cycles. The median number of retrieved oocytes per COS cycle was 11 (5-39) and the median number of cryopreserved oocytes was 7 (0-35). None of the patients undergoing FPP demand to use their cryopreserved oocytes at the time of the study completion.

While this represents a moderate cohort of patients, our results demonstrate the low adherence to FPP after FSS for BOT underlining the need of an objective and personalized information for shared decision making to accept FPP.