CION Ameerpet
You have been told there is a tumour on one ovary, and the first thing you wanted to ask was whether you can still have a baby. For some women the answer is genuinely yes — the affected ovary and its tube come out, and the uterus and the other ovary stay. Whether that is reasonable in your case is decided by the tumour type and by how completely it is staged, not by how much you want it.
The standard operation for ovarian cancer takes both ovaries, both tubes, the uterus and the omentum. Fertility-sparing surgery does something narrower: the affected ovary and its fallopian tube are removed, and the uterus and the other ovary are left in place. The formal name for that part of it is a unilateral salpingo-oophorectomy. Everything else about the operation stays the same.
That last sentence is the one most women miss, and it matters more than anything else on this page. Keeping an ovary does not mean a smaller operation. The surgeon still washes the abdomen and sends the fluid for cytology, still inspects and biopsies the lining of the abdomen, still removes the omentum where the tumour type calls for it, and still samples lymph nodes where they are indicated. All of that exists to prove the disease really is confined to the ovary you are giving up. If it is not confined, keeping the second ovary is not conservative — it is a gamble.
Women searching fertility sparing surgery ovarian cancer are usually asking two questions at once: can I still carry a pregnancy, and am I trading away safety to do it? For the right tumour, completely staged, the trade is much smaller than it feels. For the wrong tumour there is no trade to make, because the operation is not on offer. Which of those two situations you are in is settled by the pathology report, not by how badly you want a child.
The ovary with the tumour and its fallopian tube, plus the staging specimens — washings, peritoneal biopsies, usually the omentum, and lymph nodes where the tumour type calls for it.
The uterus, so a pregnancy can be carried, and the second ovary, so you keep your own eggs, your own cycle and your own hormones instead of going into surgical menopause.
The staging. This is a full staging operation with one ovary left behind, not a shortened version of one. That is precisely what makes it defensible.
Fertility-sparing surgery is not a compromise made against the guidelines — it sits inside them. NCCN’s ovarian cancer guidance states that removing only the affected ovary and fallopian tube, with comprehensive surgical staging, may be considered in a woman who wishes to preserve fertility, in early-stage disease and in the lower-risk tumour types — borderline tumours, malignant germ cell tumours and sex cord-stromal tumours — that most often affect women in their twenties and thirties. The condition attached is the staging, not the age. FIGO stage IA means the tumour is limited to one ovary, the capsule is intact, there is no tumour on the ovarian surface and the washings are clear. Without complete staging nobody can verify that sentence — and the whole decision rests on it. Source: NCCN Clinical Practice Guidelines, Ovarian Cancer; FIGO ovarian, fallopian tube and peritoneal cancer staging (2014).
Ovarian tumours are not one disease. The tumour type and grade on your pathology report, and the stage after complete staging, decide whether keeping an ovary is reasonable. Age and intention do not. Here is where each group sits, from the most permissive to the least.
Borderline tumours, also called tumours of low malignant potential, are not frank cancers. Their cells look abnormal but they do not invade the way carcinoma does, they occur disproportionately in women under 40, and they behave indolently. Removing the affected ovary and tube, with staging, is the usual approach in a woman who wants children — not an exception made for her.
Two honest caveats. These tumours recur in the retained ovary more often than the more radical operation would allow, and that recurrence usually means further surgery rather than a change in outlook. And where both ovaries are involved, removing the tumour from the second ovary while conserving ovarian tissue is sometimes considered — a decision for a specialist gynaecologic-oncology team rather than a general gynaecologist.
Germ cell tumours arise from the egg-producing cells and occur mostly in teenagers and women in their twenties. They are the one ovarian malignancy where fertility-sparing surgery is standard practice even when disease has spread beyond the ovary, because the uterus and opposite ovary are usually not involved, and because these tumours respond to platinum-based chemotherapy exceptionally well.
That makes getting the diagnosis right before theatre unusually important. A young woman with a solid ovarian mass should have germ cell markers measured before her operation, because the result changes what the surgery should be. Read more about the types of ovarian cancer and where each one sits.
These arise from the hormone-producing cells of the ovary, are usually one-sided, and are usually found at stage I because their hormonal effects — irregular bleeding, or unexpected hormonal symptoms — bring women in early. Removing the affected ovary and tube with staging is a reasonable option in stage I disease for a woman who wants to keep her fertility.
The caveat here is time rather than stage. Granulosa cell tumours can recur many years after treatment, sometimes more than a decade later, so follow-up is long and the retained ovary is watched. That is a commitment worth understanding before you choose it, not a reason to rule it out.
This is the group where the conversation is most careful, because epithelial ovarian cancer is a true carcinoma. Where the tumour is confined to one ovary with an intact capsule, the grade is low, the washings are clear and staging is complete — in other words genuine, verified stage IA grade 1 disease — fertility-sparing surgery may be considered rather than removing everything.
Grade 2 tumours, and stage IC where the capsule ruptured or the washings were positive, sit in a grey zone that is decided case by case at a tumour board and not by a rule. If your report says stage IC, read what stage 1 ovarian cancer actually means before you assume the answer either way.
High-grade serous carcinoma is the commonest ovarian cancer overall and the one least suited to ovarian conservation. It is rarely genuinely confined to one ovary, it often begins in the fallopian tube rather than the ovary itself, and microscopic spread is assumed even when the scans look limited. It is also uncommon in women of childbearing age.
Where it does occur in a younger woman, the operation offered is the full one, and the fertility conversation moves to egg or embryo storage before chemotherapy and, later, to surrogacy. That is a hard thing to be told. It is still better told before the operation than after it.
Clear cell carcinoma behaves differently from low-grade endometrioid or mucinous tumours of the same stage: it recurs more often, and it responds less predictably to platinum-based chemotherapy. Even at stage IA it is not a routine yes, and any decision to conserve an ovary in clear cell disease belongs at a tumour board with the full pathology in front of it.
The same caution applies to any tumour where the final histopathology disagrees with what was expected in theatre. A frozen section taken during surgery is a working answer, not the final one, and plans that were reasonable on the day are sometimes revised a week later.
An inherited BRCA1 or BRCA2 variant changes this decision completely, because the retained ovary and tube carry a continuing lifetime risk of a second, unrelated cancer that no operation on the first one removes. Ovarian conservation is generally not appropriate for a carrier, and where it is attempted at all it is time-limited, with an agreed plan for completion surgery once childbearing is finished.
This is the strongest argument for testing before the operation rather than after it. Genetic counselling and BRCA and HRD testing are delivered in-house at CION, and a result that arrives in time can change what is done in theatre — including whether egg or embryo storage should happen first.
The same cancer operation, with different amounts of tissue removed. This is what it means in practice to keep one ovary rather than lose both.
| Fertility-sparing: one ovary and tube removed | Standard: both ovaries, both tubes and the uterus | |
|---|---|---|
| Periods and hormones | Continue from the remaining ovary. No surgical menopause, and no immediate need for hormone support. | Menopause begins straight away, whatever your age, and how to manage it has to be planned. |
| Carrying a pregnancy | Possible. The uterus is kept and the remaining ovary supplies the eggs. | Not possible with your own uterus. Stored eggs or embryos with a surrogate become the route. |
| Staging performed | Full staging — washings, peritoneal biopsies, omentum, and nodes where indicated. | Full staging, identical. The staging is never the part that is reduced. |
| Who it is offered to | Selected stage I disease: borderline, germ cell and sex cord-stromal tumours, and low-grade stage IA epithelial cancers. | Everyone else — and anyone whose staging turns out worse than the scans predicted. |
| Follow-up | Closer, and it includes watching the retained ovary, usually with clinical review and ultrasound. | Follow-up without an ovary left to watch, though the rest of the surveillance is similar. |
| A second operation later | Often discussed once childbearing is complete, particularly with higher-risk histology or an inherited variant. | Not applicable. The surgery is already complete. |
*Which column you belong in is set by the pathology and the staging, not by preference — and it can change after the first operation if the final report reads worse than the scans suggested. Surgery of either kind is coordinated with specialist gynaecologic-oncology partner centres and may be billed there; see how ovarian cancer treatment is organised in Hyderabad.
None of these means giving up on having a family — other routes exist and are worth planning early. Each one is a reason why leaving the second ovary in place would not be safe.
Deposits on the peritoneum, positive washings or involved nodes mean the disease is not confined. Conserving the other ovary then leaves tissue behind in a field already involved.
This subtype is rarely truly limited to one ovary and microscopic spread is assumed, so ovarian conservation is not offered for it.
If tumour is present in both ovaries there is nothing left to spare. Borderline tumours are the one partial exception, and are handled on their own terms.
An inherited variant means the retained ovary and tube carry ongoing risk of a second cancer. Test before the decision, not after it.
A cyst removed elsewhere and found to be malignant afterwards is a common story. Until staging is completed, no one can honestly call it stage IA.
A suspicious appearance on the second ovary, on imaging or during the operation, changes the plan in theatre. Agree in advance what the surgeon should do.
If one of these applies to you, the useful next conversation is not about the operation. It is about egg or embryo storage before chemotherapy starts, and about what a family can look like afterwards — both of which are easier to arrange before treatment begins than during it.
A free 45-minute consultation with your scans, tumour markers and any pathology report. If fertility-sparing surgery is reasonable in your case, we will say so and coordinate it. If it is not, you will hear that plainly, along with the routes to a family that are still open.
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Trained at AIIMS, Tata Memorial and leading international centres. Combined 150+ years of experience. Every complex case is reviewed by 3+ of them - together.
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
MBBS, MS(General Surgery), M.Ch(Surgical Oncology), FMAS, FARIS(Ongoing)
MBBS, MS (General Surgery), DrNB (Surgical Oncology), FALS Oncology
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No referral needed and no cost for the first consultation. Bring your scans and your pathology report — the answer on fertility usually sits inside them.
Fertility-sparing surgery is one decision inside a sequence, and the order matters more than most people are told. Much of what protects your fertility happens before and after the operation rather than during it.
Pelvic ultrasound, an MRI where the mass is indeterminate, and tumour markers chosen for your age and the appearance of the mass — CA-125 and HE4 in an older woman, germ cell markers in a young woman with a solid mass, and inhibin B where a granulosa tumour is suspected. In a woman under 30, the markers ordered before surgery can change what the right operation is.
A surgeon who has not been told cannot preserve anything. Your intention to have children should be written into the plan, and the consent conversation should cover the awkward scenario explicitly: what you want done if the second ovary looks abnormal once the abdomen is open. Decide that with a clear head, not through a relative in a corridor.
The affected ovary and tube are removed, ideally intact, because rupturing the cyst spills cells and can change the stage. Washings, peritoneal biopsies, omentum and lymph nodes follow as the tumour type requires. This surgery is coordinated with specialist gynaecologic-oncology surgeons at partner centres and may be billed there — CION says so upfront rather than leaving it to be discovered on an invoice.
The frozen section during surgery is a working answer. The final report, usually about a week later, is the one that counts, and it sometimes upgrades the grade or reclassifies the tumour type. If it does, the plan can change — including a recommendation for further surgery. That possibility should be described to you before the first operation, not sprung afterwards.
Where the tumour type, grade or stage calls for it, platinum-based chemotherapy follows. It can reduce ovarian reserve, though in younger women periods often return. If there is time, egg or embryo storage at a reproductive medicine unit before starting is the reliable option; ovarian suppression with a GnRH-agonist-class drug during chemotherapy is sometimes added. Chemotherapy itself is delivered in-house at CION across 35+ centres.
Follow-up includes watching the retained ovary, usually with clinical review and ultrasound. Your team will give you a timeline for when it is reasonable to start trying, based on your tumour type and the treatment you had. Tests of ovarian reserve help decide whether to try naturally or to seek fertility help early rather than after a year of disappointment. More on ovarian cancer and fertility.
Two things go wrong most often, and both are avoidable. A cyst is removed at a hospital that did not expect cancer, with no markers and no staging. Or fertility is never raised until chemotherapy is already booked and there is no longer time to store eggs. Setting the sequence at the start prevents both.
This is the question almost every woman is thinking and very few ask out loud, so here is the fair summary. In carefully selected women — early stage, favourable tumour type, complete staging — the published series comparing fertility-sparing surgery with the radical operation have not shown worse survival. That is why the approach is in the guidelines at all.
But notice how much work the phrase carefully selected is doing. Those series are retrospective, and the women in them were chosen precisely because their disease looked confined and their tumours looked favourable. Published survival for stage I is also averaged across substages, across grades and across tumour subtypes that behave very differently, and it is drawn from years of practice that have since changed. A single percentage taken from that mixture cannot be narrowed down to one woman, and anyone who quotes you one is guessing.
The practical consequence is this: the risk in fertility-sparing surgery does not really sit in the concept. It sits in the selection. The cases that go wrong are the ones where staging was incomplete, or where a histology that was never suitable was managed as though it were stage IA. That is why this page keeps returning to the pathology report rather than to the operation.
CION ovarian cancer patients alive at one year from diagnosis. *One-year survival, CION treated population.
The comparable national figure for ovarian cancer. *One-year survival; national registry data.
One-year survival describes a whole treated population. It is not a cure rate and not a forecast for you — stage, tumour subtype and completeness of staging matter far more to your own outlook.
*One-year survival rates. CION figures reflect CION's treated patient population; national figures are drawn from published Indian cancer registry data. Survival statistics describe groups, not individuals — discuss your own outlook with your treating oncologist.
Many women reach this page holding a scan report they cannot read and a surgery date nobody asked them about, with the question of children never once raised. That is the gap worth closing, and it usually takes an hour rather than a second opinion on the diagnosis itself.
Your first consultation at CION is free and runs to about 45 minutes. Bring your scans, your tumour marker results and any pathology report, including from a cyst removed elsewhere. Every case is discussed at a tumour board rather than decided by one doctor, and where we think the sequence should change — markers before surgery, genetic testing before the decision, egg storage before chemotherapy — we will say so while there is still time to act on it.
We should be plain about who does what, because it affects where you will be and who bills you. Fertility-sparing surgery, staging surgery, debulking, HIPEC, intraperitoneal chemotherapy and PET-CT are coordinated with specialist gynaecologic-oncology partner centres and may be billed there. That is deliberate — this is an operation where specialist volume changes the result. Chemotherapy, maintenance therapy, genetic counselling, BRCA and HRD testing, nutrition support and follow-up are delivered in-house at CION across 35+ centres in Telangana and Andhra Pradesh. Egg and embryo storage is done at a reproductive medicine unit, and that referral is worth making before chemotherapy is booked rather than after.
Free and unhurried. Long enough to read the pathology properly and to fix the order of decisions before a surgery date closes options off.
Medical oncology, imaging, pathology and the surgical team review the same case together — which is the right setting for a borderline fertility decision.
Performed by specialist gynaecologic-oncology surgeons at partner centres and may be billed there. Stated upfront, not discovered later.
Counselling with BRCA and HRD testing at CION, because for this decision a carrier result changes the operation itself, not just the follow-up.
It is an operation that removes the ovary containing the tumour together with its fallopian tube — a unilateral salpingo-oophorectomy, often shortened to unilateral oophorectomy — while leaving the uterus and the opposite ovary in place, so that carrying a pregnancy remains possible. It is not a smaller cancer operation. The same comprehensive staging is done: peritoneal washings sent for cytology, inspection and biopsy of the lining of the abdomen, removal of the omentum where the tumour type calls for it, and lymph node assessment where indicated. That staging is the whole basis of the decision, because conserving the second ovary is only reasonable if the disease is genuinely confined to the one being removed.
In most cases yes. A single ovary generally takes over and releases an egg each cycle, and because the uterus is kept a pregnancy can be carried normally. Two things influence how straightforward it turns out to be. The first is whether you need chemotherapy afterwards, which can reduce ovarian reserve, although in younger women periods commonly return. The second is time — your team will advise when it is reasonable to start trying, based on your tumour type and treatment. Tests of ovarian reserve are useful early, because they help decide whether to try naturally or to see a fertility specialist sooner rather than after a year of trying.
For carefully selected women it does not appear to worsen survival, which is why the approach is in the guidelines. Recurrence in the retained ovary is possible, and it is more common with borderline tumours — where it usually means further surgery rather than a change in outlook. The honest risk lies elsewhere: in cases where staging was incomplete, or where a tumour type that was never suitable, such as high-grade serous carcinoma, was managed as though it were stage IA. That is why complete staging and a final histopathology review matter more here than in almost any other ovarian cancer decision, and why the retained ovary is kept under surveillance afterwards.
Anyone whose disease is not confined to one ovary. Deposits on the peritoneum, positive washings or involved lymph nodes rule it out, as does tumour in both ovaries, with borderline tumours the one partial exception. High-grade serous carcinoma is not managed this way at any stage, because it is rarely truly limited and microscopic spread is assumed. Clear cell carcinoma is not a routine yes even at stage IA and belongs at a tumour board. Carrying a BRCA1 or BRCA2 variant generally argues against conserving an ovary, because the retained ovary and tube keep a lifetime risk of a separate cancer. And where staging was never completed, no one can honestly call the disease stage IA in the first place.
Sometimes. It depends on the tumour type, the grade and the final stage: some completely staged stage IA tumours are managed with surveillance alone, while germ cell tumours and higher-risk epithelial cancers usually need platinum-based chemotherapy. Chemotherapy can reduce ovarian reserve and may delay the return of periods, though many younger women resume cycles afterwards. If there is time before treatment starts, storing eggs or embryos at a reproductive medicine unit is the most reliable safeguard, and ovarian suppression during chemotherapy is sometimes added. The important point is timing — that conversation has to happen before the first cycle is given, not once treatment is underway.
It is often discussed, and for some women it is strongly advised rather than optional. Completion surgery means removing the remaining ovary and tube, sometimes with the uterus, once childbearing is complete. It is recommended most firmly where an inherited BRCA1 or BRCA2 variant is present, and considered where the histology carried a higher risk of recurrence. For a young woman with a fully staged borderline or germ cell tumour it may never be needed at all. What matters is that the possibility is agreed at the start rather than raised years later, so that follow-up and family planning are built around one plan instead of two.
The first consultation is free and runs to about 45 minutes. CION delivers medical oncology for ovarian cancer in-house — chemotherapy and maintenance treatment across more than 35 centres in Telangana and Andhra Pradesh — along with genetic counselling and BRCA and HRD testing, nutrition support and long-term follow-up. Fertility-sparing surgery, staging surgery, debulking, HIPEC, intraperitoneal chemotherapy and PET-CT are coordinated with specialist gynaecologic-oncology partner centres and may be billed there, and we say so upfront rather than leaving it to be discovered later. Every case is reviewed at a tumour board, and egg or embryo storage is arranged with a reproductive medicine unit before chemotherapy begins.