Fertility-sparing surgery and fertility preservation in cervical cancer: The desire for parenthood, reproductive and obstetric outcomes

R.C.J Van Der Plas,A.M.E Bos,I.M Jürgenliemk-Schulz,C.G Gerestein,R.P Zweemer

doi:10.1016/j.ygyno.2021.09.003

R.C.J Van Der Plas, A.M.E Bos + Show 3 more

Open Access

https://doi.org/10.1016/j.ygyno.2021.09.003

Copy DOI

Journal: Gynecologic oncology	Publication Date: Sep 25, 2021
Citations: 8	License type: cc-by

Affiliation: University Medical Center Utrecht

Abstract

ObjectiveTo evaluate the desire for parenthood and reproductive outcomes of young cervical cancer survivors who underwent fertility-sparing surgery or fertility preservation procedures for invasive cervical cancer. MethodsAll women <45 years who underwent fertility-sparing treatment for invasive cervical cancer in a tertiary referral center in the Netherlands between January 2009 and January 2020 were identified. Fertility-sparing treatment options included Vaginal Radical Trachelectomy (VRT) for patients with early-stage disease and fertility preservation techniques (FP) when requiring Radical Hysterectomy (RH) or chemoradiotherapy. Data on reproductive intentions – and outcomes were retrieved from medical files and questionnaires. Results75 patients were identified of whom 34 underwent VRT, 9 RH and 32 had (chemo)radiotherapy. 26 patients started FP of whom 23 (88.5%) successfully preserved fertility through cryopreservation of embryos, oocytes and ovarian tissue. After a median follow-up of 49 months, 5 patients developed recurrent disease and died. Reproductive outcomes were retrieved in 58 patients. 89.6% maintained their desire for parenthood after cancer treatment. Following VRT, we report a pregnancy rate of 61.9% among the patients attempting conception (n = 24). 15 patients conceived 21 pregnancies which resulted in 15 live-births, yielding a live-birth rate of 75.0%. Following RH or (chemo)radiotherapy, 3 surrogate pregnancies were established (21.4%) using frozen-thawed material with good neonatal outcomes. ConclusionMany cervical cancer survivors maintain the desire to become parents eventually. In early-stage disease, VRT shows good reproductive outcomes without compromising oncological safety. For those requiring gonadotoxic treatment fertility preservation and gestational surrogacy provides a promising alternative for achieving a biological offspring.

Highlights

Cervical cancer is the fourth most common cancer among women worldwide and affects women at a significantly younger age than⁎ Corresponding author at: UMC Utrecht Cancer Center, Department of Gynecological Oncology, University Medical Center Utrecht, PO Box 85500, 3584CX Utrecht, the Netherlands.Please cite this article as: R.C.J. van der Plas, A.M.E
In early-stage disease, Vaginal Radical Trachelectomy (VRT) shows good reproductive outcomes without compromising oncological safety. For those requiring gonadotoxic treatment fertility preservation and gestational surrogacy provides a promising alternative for achieving a biological offspring
34 patients were treated with vaginal radical trachelectomy, 9 with radical hysterectomy and 32 patients withradiotherapy

Summary

Introduction

Cervical cancer is the fourth most common cancer among women worldwide and affects women at a significantly younger age than. ⁎ Corresponding author at: UMC Utrecht Cancer Center, Department of Gynecological Oncology, University Medical Center Utrecht, PO Box 85500, 3584CX Utrecht, the Netherlands. R.C.J. van der Plas, A.M.E. Bos, I.M. Jürgenliemk-Schulz et al.90% for early-stage disease, the desire for fertility-sparing treatment modalities rises [5]

Methods

Results

Discussion

Conclusion