Journal of Gynecologic SurgeryReview of Fertility Preservation in Ovarian Cancer

Ovarian cancer affects 12% of reproductive-age patients, yet only 14.6% of eligible women receive REI referrals after diagnosis. This review defines fertility-sparing surgery candidates, outlines cryopreservation options, and proposes an algorithm for concurrent oncologic and fertility care. System, provider, and patient barriers continue to drive low referral rates despite clear society guidelines from NCCN, ASCO, and ASRM.

Clinical Considerations

• Fertility-sparing surgery is appropriate for Stage I epithelial/sex cord stromal tumors and all stages of germ cell and borderline tumors
• Paclitaxel carries the highest POI risk among first-line agents; platinum agents have not been shown to increase ovarian failure risk
• GnRH agonists remain controversial for ovarian preservation and should not replace proven methods outside research settings
• BRCA1 carriers show diminished ovarian stimulation response, lower AMH, and reduced oocyte yield, requiring earlier referral

Practice Applications

• Order AMH and transvaginal ultrasound with antral follicle count at diagnosis for all reproductive-age patients
• Refer to REI immediately at diagnosis, even when patients are uncertain about fertility goals
• Counsel BRCA and Lynch syndrome patients on fertility preservation before risk-reducing surgery
• Connect patients with financial navigators and mental health services to address barriers to fertility care

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