Fertility and ovarian function after conservative surgery for germ cell tumours of the ovary

Malignant ovarian germ cell tumours (MOGCT) principally occur in girls and young women and are generally unilateral. Effective combination chemotherap y with conservative surgery has seen a dramatic improvement in survival rat es. This increase has shifted the focus to long-term fertility and reproduc tive outcome. The present study describes 45 patients with MOGCT treated wi th conservative surgery to preserve fertility, with or without the addition of chemotherapy. The age range was 10 to 32 years with a mean of 20 years. The majority of the subjects had Stage 1 tumours; 44 underwent unilateral salpingo-oophorectomy and 1 patient ovarian cystectomy. Adjuvant chemothera py was administered in 29 patients. Overall mean follow-up was 58.7 months. There were 4 recurrences and 2 deaths. Survival of those with Stage 1 dise ase was 97% and for advanced stages 87%. During chemotherapy 50% became ame norrhoeic but 96% resumed normal menstrual function on completion. Seven he althy babies were recorded in the chemotherapy group and no documented birt h defects occurred in any of these. There was no case of persistent inferti lity; 3 patients experienced temporary problems. It is concluded that conse rvative fertility-sparing surgery is the treatment of choice in these young women and advanced disease is not necessarily a contraindication. The majo rity can anticipate normal menstrual function and fertility.