It is almost always the first question, and the most legitimate one. Because a borderline tumor is not a cancer and often affects young women, surgery can frequently preserve fertility. My role is surgical: what then relates to conception is handled by a reproductive medicine specialist, whom I do not replace.
Surgery is designed to keep as much healthy ovarian tissue as possible; assisted reproduction itself is handled by a reproductive medicine specialist. Consultations in Paris 8th, surgery at the Clinique Hartmann in Neuilly.
This article focuses on fertility; for the full clinical overview, see the dedicated borderline tumors page.
Learning you have an ovarian tumor before having a child — or when you want more — creates a particular anxiety. A borderline tumor is not an ovarian cancer in the strict sense, and it often occurs in young women. — CNGOF 2020
These two features open, in many cases, the possibility of surgery that preserves fertility. — ESGO/ESHRE/ESGE 2024 This article does not repeat the whole borderline-tumor file — definition, types and prognosis are on my dedicated reference page — it answers a single question, in depth: "will I be able to have a child?".
One essential clarification: I am a surgeon and I do not perform assisted reproduction (IVF). When assisted reproduction is useful, it is carried out by a reproductive medicine specialist to whom I refer; the operation is simply designed to best preserve those options. — ESGO/ESHRE/ESGE 2024
Beware of a common shortcut: it is not because the tumor "would not be atypical". The cells of a borderline tumor are atypical. What allows the ovary to be preserved is that they do not invade the stroma — it is the absence of invasion, not the absence of atypia, that separates a frontier tumor from a cancer. — CNGOF 2020
Atypical proliferation but no destructive invasion of the ovary: the lesion can often be removed without taking everything, and without chemotherapy — not indicated as a rule. — CNGOF 2020
Frequently around the age of forty, often at a stage limited to the ovary: two favorable conditions for fertility-sparing surgery. — ecancer review
European recommendations explicitly encourage fertility preservation, including in situations that once gave pause. — ESGO/ESHRE/ESGE 2024
Who this concerns. Fertility-sparing surgery can be considered at any stage when peritoneal implants are non-invasive, and even with microinvasion or a micropapillary form — these patients then being informed and referred to a reproductive specialist. — ESGO/ESHRE/ESGE 2024
Overall, when the disease affects only one ovary, we perform a unilateral cystectomy, or a unilateral salpingo-oophorectomy — the goal being to keep as much healthy, functional ovarian tissue as possible. — ESGO/ESHRE/ESGE 2024
Removing the diseased part while keeping the rest of the ovary: preserves the most ovarian reserve, sometimes the only option if both ovaries are involved. — ESGO/ESHRE/ESGE 2024
Removing the ovary and tube on the affected side, keeping the other ovary and the uterus: a healthy remaining ovary is enough to ovulate and carry a pregnancy. — ESGO/ESHRE/ESGE 2024
The trade-off, plainly: keeping ovarian tissue increases the risk of local recurrence — up to about 30% after cystectomy across series — but these recurrences most often reappear as a borderline form and do not change survival. — ESGO/ESHRE/ESGE 2024 For mucinous forms, salpingo-oophorectomy is often preferred; radical surgery is reserved for after menopause or once the parental plan is complete. — CNGOF 2020 These procedures are part of my ovarian and tubal surgery, by laparoscopy, with the precautions that avoid cyst rupture. — CNGOF 2020
Once fertility-sparing surgery is done and the final analysis is reassuring, the question becomes concrete: when to try, and with what chances?
After confirming the absence of invasive implants, a spontaneous pregnancy can generally be considered without a particular delay. — ESGO/ESHRE/ESGE 2024
A functional remaining ovary keeps ovulating; the probability of pregnancy depends mainly on age and ovarian reserve. — ESGO/ESHRE/ESGE 2024
Ultrasound follow-up continues while trying to conceive and during pregnancy, with the obstetric team. — CNGOF 2020
No individual figure: fertility after a borderline tumor depends on too many personal factors — age, ovarian reserve, extent of surgery — for an individual percentage to mean anything. The aim of the operation is to preserve these chances as much as possible, with referral to a reproductive specialist when needed. — ESGO/ESHRE/ESGE 2024
Let me be clear from the outset: I do not perform assisted reproduction (IVF). My role stops at surgery. Assisted reproduction is carried out by a reproductive medicine specialist or a fertility centre, to whom I refer. For your information:
IVF and other techniques possible, including after complete surgery, provided invasive implants have been ruled out. — ESGO/ESHRE/ESGE 2024
In higher-relapse-risk situations (micropapillary, implants), egg or embryo freezing may be offered after surgery. — ESGO/ESHRE/ESGE 2024
Timing, technique and stimulation safety are decided with the specialist; the strategy stays consistent with oncological follow-up. — ESGO/ESHRE/ESGE 2024
To be perfectly clear: I do not carry out assisted reproduction or egg preservation myself. I am a surgeon; my role stops at an operation designed to preserve your options. Stimulation, IVF and freezing are performed by a reproductive medicine specialist, to whom I refer. — ESGO/ESHRE/ESGE 2024
A borderline tumor is sometimes spotted during a pregnancy ultrasound. It is unsettling, but it can be managed with the right framework.
Surgeon, obstetrician, radiologist and pathologist take into account the term and the appearance of the mass; surgery may be deferred or combined with the caesarean depending on the case. — Annals of Oncology 2019
Borderline tumors diagnosed during pregnancy more often display aggressive features: this warrants increased vigilance, without dramatizing or giving up the pregnancy. — Annals of Oncology 2019
The practical message: a borderline tumor found while pregnant does not mean giving up the pregnancy; the goal is to protect both mother and child, adapting the surgical timing case by case. — Annals of Oncology 2019
A frequent question after fertility-sparing surgery — and the answer often surprises, in a good way. — ESGO/ESHRE/ESGE 2024
Removing the preserved ovary is not recommended routinely: it is an option to discuss case by case. — ESGO/ESHRE/ESGE 2024
As recurrences can be late, follow-up (exam + ultrasound) continues for several years, often at least ten. — CNGOF 2020
If completion is done before menopause, hormone replacement therapy may be considered after discussion. — ESGO/ESHRE/ESGE 2024
Sources & guidelines: ESGO / ESHRE / ESGE (fertility-sparing treatment, 2024-2025), CNGOF (Borderline ovarian tumours, 2020), French multicenter study on borderline tumors diagnosed during pregnancy (Annals of Oncology, 2019), French-speaking Observatory of rare ovarian tumors (2025). General information, not a substitute for a consultation.
Facing a borderline tumor with a wish for a child, the surgeon's role is to design an operation that protects both health and the plan for motherhood.
Examinations and parental plan reviewed from the start, to build fertility preservation into the surgical decision.
Unilateral cystectomy or salpingo-oophorectomy, by laparoscopy whenever possible. No robot or vNOTES: where relevant, referral to a colleague.
I do not perform assisted reproduction. Referral to a reproductive specialist for ART; strategy validated by the tumor board.
Consultations at 241 rue du Faubourg Saint-Honoré (Paris 8th), surgery at the Clinique Hartmann in Neuilly. Sector 2.
Often, yes. Fertility-sparing surgery is frequently possible in a young woman, and a spontaneous pregnancy can then be considered. It depends on age, ovarian reserve and the extent of surgery. — ESGO/ESHRE/ESGE 2024
Yes, in suitable situations: local recurrence is more frequent, but most often as a borderline form, and survival is not changed. Decision validated by the tumor board after staging. — ESGO/ESHRE/ESGE 2024
A functional remaining ovary keeps ovulating and allows pregnancy; the probability depends mainly on age and ovarian reserve. — ESGO/ESHRE/ESGE 2024
After fertility-sparing surgery that has ruled out invasive implants, pregnancy can often be considered without an imposed delay. — ESGO/ESHRE/ESGE 2024
Yes, ART is possible, including after complete surgery, provided invasive implants have been ruled out on the pathology report. These decisions are made with a reproductive medicine specialist: I do not perform assisted reproduction myself. — ESGO/ESHRE/ESGE 2024
Multidisciplinary, individualized management according to the term and appearance. These tumors then more often display aggressive features, hence close surveillance. — Annals of Oncology 2019
Not necessarily: "completion" surgery is not automatic, it is an option to discuss once the parental plan is complete. — ESGO/ESHRE/ESGE 2024
As a gynecologic cancer surgeon and gynecologist, I handle the surgical part of borderline tumors, together with the tumor board and reproductive medicine. See also my reference page and ovarian cancer.
To understand the disease beyond the question of fertility.
The full picture: definition, types, diagnosis, surgery and follow-up of frontier tumors.
SurgeryCystectomy, salpingo-oophorectomy, laparoscopy: how operations on the ovary are performed.
OverviewTo tell a borderline tumor apart from an invasive cancer: differences, management, prognosis.
UnderstandThe microscopic analysis that confirms the diagnosis and guides fertility preservation.
SurgeryWhen the uterus is involved: the possible gestures and their impact on fertility.
The pathwayThe overview of care: ovary, cervix, endometrium, vulva.
Let's talk early. Dr Jérémie Zeitoun sees patients at the practice in the 8th arrondissement of Paris and operates at the Clinique Hartmann in Neuilly-sur-Seine. Bring your imaging and pathology reports.
General information, not a substitute for a consultation; assisted reproduction is performed by a reproductive medicine specialist, not by the surgeon.