Growing teratoma syndrome (GTS) is a rare condition among women with ovarian germ cell tumours. Women with GTS classically present during or after systemic chemotherapy with normalised tumour markers and a mass pathologically consistent with mature teratoma. Awareness of this syndrome is necessary to prevent unnecessary chemotherapy and allow optimal management. We report five cases of ovarian GTS as examples of the clinical dilemmas encountered with these women and provide recommendations and an algorithm to guide potential management.