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Background <p>Controlled ovarian stimulation (COS) is a feasible method for treating borderline ovarian tumors (BOTs) after fertility-sparing surgery (FSS). The recurrence rate does not appear to be higher in women treated with COS, and it is important to assess its effects on the pregnancy rate. There have been no reports comparing different COS regimens in patients with BOTs.</p> Methods <p>This retrospective observational study included 73 BOT patients who underwent COS. Patients were divided into two groups according to the COS regimen: the mild stimulation group (36 patients) and the agonist/antagonist cycle group (37 patients). In this study, the effects of the COS regimens on pregnancy outcomes and the risk of tumor recurrence were compared.</p> Results <p>The follow-up time among the 73 patients was 61 (7–156) months. The proportion of patients with a serous histopathology and a micropapillary architecture was 33.3% in the mild stimulation group, which was significantly greater than that in the agonist/antagonist cycle group (<i>P</i> = 0.045). The initial dose of gonadotropin (Gn), the total dose of Gn, the duration of Gn treatment, and estradiol (E<sub>2</sub>) on trigger day were significantly lower in the mild stimulation group than in the agonist/antagonist cycle group. Furthermore, the number of oocytes retrieved, the number of good-quality embryos produced and the number of embryos frozen was also significantly lower in the mild stimulation group. The cumulative live birth rate (CLBR) was 46.4% (13/28) in the mild stimulation group and 53.3% (16/30) in the agonist/antagonist cycle group, and the difference between the two groups was not significant (<i>P</i> = 0.599). E<sub>2</sub> on trigger day (HR: 15.217, 95%CI: 1.215–190.595, <i>P</i> = 0.035) and the total dose of Gn (HR: 12.578, 95%CI: 1.035–152.888, <i>P</i> = 0.047) were independent factors affecting tumor-related outcomes. However, the COS protocol had no significant effect on the tumor-related outcome (<i>P</i> = 0.122).</p> Conclusion <p>E<sub>2</sub> on trigger day and the total dose of Gn are independent factors affecting the tumor-related outcome. Overstimulation of the ovaries should be avoided. Mild stimulation regimens and agonist/antagonist cycle regimens are both safe and effective for treating infertile patients with BOTs. Mild stimulation is more suitable and safer for patients with high-risk factors such as recurrence prior to COS and a serous histopathology with a micropapillary architecture.</p>

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Tumor recurrence risk following different COS regimens in infertile women with borderline ovarian tumors: impact on IVF outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月12日

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  • Liang Liang,
  • Yuan Li,
  • Xiu-Mei Zhen,
  • Jie Yan,
  • Xue-Ling Song,
  • Rong Li

摘要

Background

Controlled ovarian stimulation (COS) is a feasible method for treating borderline ovarian tumors (BOTs) after fertility-sparing surgery (FSS). The recurrence rate does not appear to be higher in women treated with COS, and it is important to assess its effects on the pregnancy rate. There have been no reports comparing different COS regimens in patients with BOTs.

Methods

This retrospective observational study included 73 BOT patients who underwent COS. Patients were divided into two groups according to the COS regimen: the mild stimulation group (36 patients) and the agonist/antagonist cycle group (37 patients). In this study, the effects of the COS regimens on pregnancy outcomes and the risk of tumor recurrence were compared.

Results

The follow-up time among the 73 patients was 61 (7–156) months. The proportion of patients with a serous histopathology and a micropapillary architecture was 33.3% in the mild stimulation group, which was significantly greater than that in the agonist/antagonist cycle group (P = 0.045). The initial dose of gonadotropin (Gn), the total dose of Gn, the duration of Gn treatment, and estradiol (E2) on trigger day were significantly lower in the mild stimulation group than in the agonist/antagonist cycle group. Furthermore, the number of oocytes retrieved, the number of good-quality embryos produced and the number of embryos frozen was also significantly lower in the mild stimulation group. The cumulative live birth rate (CLBR) was 46.4% (13/28) in the mild stimulation group and 53.3% (16/30) in the agonist/antagonist cycle group, and the difference between the two groups was not significant (P = 0.599). E2 on trigger day (HR: 15.217, 95%CI: 1.215–190.595, P = 0.035) and the total dose of Gn (HR: 12.578, 95%CI: 1.035–152.888, P = 0.047) were independent factors affecting tumor-related outcomes. However, the COS protocol had no significant effect on the tumor-related outcome (P = 0.122).

Conclusion

E2 on trigger day and the total dose of Gn are independent factors affecting the tumor-related outcome. Overstimulation of the ovaries should be avoided. Mild stimulation regimens and agonist/antagonist cycle regimens are both safe and effective for treating infertile patients with BOTs. Mild stimulation is more suitable and safer for patients with high-risk factors such as recurrence prior to COS and a serous histopathology with a micropapillary architecture.