Jia SZ, et al. - Researchers investigated young women (≤ 40 years old) with bilateral serous borderline ovarian tumors (SBOTs) after fertility-sparing surgery for their oncofertility outcomes. At the Peking Union Medical College Hospital in Beijing, China, they conducted a retrospective observational study including 94 women (≤ 40 years old) with pathologically confirmed bilateral SBOTs between January 1999 and January 2019. The patients self-selected one of three treatment modalities following preoperative counseling: bilateral ovarian cystectomy (n = 48), unilateral adnexectomy plus contralateral cystectomy (UAC; n = 31), and radical surgery (n = 15). Relapse developed in 61 patients (65%) during the median follow-up of 64 months (range, 4–243 months). In the multivariate analyses, adverse disease-free survival was observed in independent correlation with preoperative CA-125 > 300 U/mL, fertility preservation and micropapillary pattern. Invasive recurrence occurred in 14 patients (15%), and there were three (3%) patients who died of progressive disease. They observed a significant association of the micropapillary pattern with invasive evolution risk. Among the 49 patients who tried to conceive, 27 pregnancies were achieved in 23 (47%) patients (24 spontaneous and three after IVF-ET), resulting in 19 live births. The UAC and bilateral procedures did not exhibited significant difference in disease-free survival or pregnancy rate. Outcomes thereby support the feasibility of attaining fertility preservation with the bilateral ovarian cystectomy procedure for bilateral SBOTs, with an acceptable oncological outcome and worthwhile pregnancy rates.