Successful twin pregnancy by assisted reproductive technology after laparoscopic-assisted radical vaginal trachelectomy

Abstract

Because of the well-established screening program, cervical cancer is now being diagnosed in women at relatively young age and early stages. The conventional treatments for early-stage cervical cancer are abdominal radical hysterectomy (with/without salpingo-oophorectomy) or chemoradiation, which lead to definitive sterility in cases of removing both ovaries and sole radiotherapy. However, for young patients with early-stage cervical cancer who desire a fertility preservation, trachelectomy could be an alternative option. Here, we report a successful twin pregnancy by assisted reproductive technique after Laparoscopy-Assisted Radical Vaginal Trachelectomy (LARVT) to a patient with an early-stage cervical cancer. A 34-year-old nulliparous woman was diagnosed with cervical cancer IB1. She underwent LARVT with permanent transvaginal cerclage without any adjuvant treatment. Two years later, she had a twin pregnancy by a controlled ovarian hyperstimulation with an intrauterine insemination. Transvaginal ultrasonography which followed up serially showed a shortening of cervical length. Therefore, she was hospitalized at 22 5/7 weeks. She was treated with steroid for fetal lung maturation and intermittent tocolytics due to the possibility of preterm labor. At 30th weeks of gestation, she delivered a twin by emergent cesarean section due to an uncontrolled preterm labor. Both babies were admitted to the neonatal intensive care unit for two months, and were discharged without any medical problem. LARVT may be a promising surgical option for treatments of young patients with an early-stage invasive cervical carcinoma, who desire a fertility preservation.