Fortin A, Hazout A, Thoury A, Alvès K, Bats A-S, Dhainaut C, Madelenat P
Service de gynécologie-obstétrique, maternité Aline-de-Crépy, CHU Bichat-Claude-Bernard, 46, rue Henri-Huchard, 75018 Paris, France.
Gynecol Obstet Fertil. 2005 Jul-Aug;33(7-8):488-97. doi: 10.1016/j.gyobfe.2005.06.010.
Ovulation induction, the usual resort of Assisted Reproductive Technologies (ART), has been suspected of carrying a responsibility in the genesis of ovarian tumours. For patients with a borderline or invasive ovarian tumour, treated by conservative surgery and desiring to become pregnant, the problem is thus of a possible resort to the Assisted Reproductive Technologies.
This is a multicenter, national and retrospective study. 40 operated patients between January 1971 and January 2001 have been included. 27 patients (67.5%) had a borderline tumour, 10 (25%) a non-epithelial tumour (germinal or stromal) and 3 (7.5%) an epithelial invasive carcinoma. All these patients have benefited from a conservative surgical management of fertility. The Assisted Reproductive Technologies were simple stimulation for 5 women and IVF for the 35 others. The effectiveness and the risks of Assisted Reproductive Technologies have been estimated respectively by the number of pregnancies obtained and the recurrence rates.
With a global follow-up of 372 months (January 1971: date of the primary surgical procedure--June 2002: closing of the study), 17 patients have obtained 17 pregnancies with the Assisted Reproductive Technologies, rate of 42.5% (17/40): 1 spontaneous abortion, 16 delivery with 23 children (triple pregnancies and 3 twin pregnancies). 3 patients treated for a borderline tumour have had a recurrence after induction of ovulation. Among the 40 patients, no one presented an evolved disease at the last news. The patients who had a recurrence had a delay to begin the Assisted Reproductive Technologies significantly lower than the patients who had no recurrence.
The assisted reproductive technologies for patients who had been treated for a borderline or invasive ovarian tumour, and who were infertile in spite of conservative management, have allowed 42.5% of these women to obtain a pregnancy and does not seem to increase significantly the risk of recurrence.
诱导排卵是辅助生殖技术（ART）常用的手段，一直被怀疑与卵巢肿瘤的发生有关。对于接受保守性手术治疗且希望怀孕的交界性或浸润性卵巢肿瘤患者而言，因此存在是否可能采用辅助生殖技术的问题。
这是一项多中心、全国性的回顾性研究。纳入了1971年1月至2001年1月间40例接受手术的患者。27例患者（67.5%）患有交界性肿瘤，10例（25%）患有非上皮性肿瘤（生殖细胞或间质肿瘤），3例（7.5%）患有上皮性浸润癌。所有这些患者均受益于保留生育功能的保守性手术治疗。辅助生殖技术方面，5名女性采用单纯刺激排卵，其余35名采用体外受精（IVF）。辅助生殖技术的有效性和风险分别通过获得的妊娠数和复发率进行评估。
总体随访时间为372个月（1971年1月：初次手术日期——2002年6月：研究结束），17例患者通过辅助生殖技术成功妊娠，妊娠率为42.5%（17/40）：1例自然流产，16例分娩，共生育23名子女（3例三胎妊娠和3例双胎妊娠）。3例接受交界性肿瘤治疗的患者在诱导排卵后出现复发。在这40例患者中，最新消息显示无人出现病情进展。复发患者开始辅助生殖技术的时间明显短于未复发患者。
对于接受过交界性或浸润性卵巢肿瘤治疗且尽管采取了保守治疗仍不育的患者，辅助生殖技术使42.5%的此类女性成功妊娠，且似乎并未显著增加复发风险。
