Fertility results after ovarian transposition for pelvic malignancies treated by external irradiation or brachytherapy

Abstract

The aim of this study was to assess the fertility outcome after ovarian transposition with uterine conservation and pelvic irradiation therapy for pelvic cancer. A total of 37 consecutive cases were reviewed. Of these, 27 patients were treated for a clear cell adenocarcinoma of the vagina and/or the cervix (group 1), nine for an ovarian pure dysgerminoma and one for a para-uterine soft tissue sarcoma (group 2). The pregnancy rate was 15% (4/27) in group 1 and 80% (8/10) in group 2 (P=0.01). A total of 18 pregnancies was observed in 12 patients. Of these, 16 pregnancies were obtained spontaneously and two after in-vitro fertilization. Of the spontaneous pregnancies, 12 (75%) were observed with ovaries still in the abdominal cavity (not repositioned). These results show that the prognosis for fertility is excellent after ovarian transposition and irradiation in patients with morphologically normal genital tracts (group 2). The prognosis is not as good for patients treated for a clear cell adenocarcinoma of the vagina and/or the cervix who may have morphological and/ or functional anomalies of the genital tract, following exposure to diethylstilboestrol and brachytherapy (group 1). Furthermore, these results show that repositioning of the ovary is not essential to achieve pregnancy.

Fertility preservation in post-pubescent female cancer patients: A practical guideline for clinicians

“…Spontaneous pregnancies have been reported in women with transposed ovaries, without the need for re-positioning of ovaries (34). However, if infertility develops and in vitro fertilization is needed after ovarian transposition, oocyte retrieval may be more complicated (35).…”

Iatrogenic Menopause After Treatment for Cervical Cancer

“…A systematic review and meta-analysis of the outcomes of ovarian transposition in gynaecological cancers found that it was associated with the preservation of ovarian function [37] and successful pregnancy outcomes have also been reported [38], however metastases in transposed ovaries and recurrence have been reported [39]. Although this technique would not be suitable for all and care must be taken with case selection since non-squamous histology, stage and unaffected peripheral stromal thickness have been shown to be significantly associated with an increased risk of recurrence [40], it may prevent the onset of menopause in a proportion of cases as well as opening up the possibility for oocyte retrieval and pregnancy through surrogacy [41].…”

Fertility Protection in Female Oncology Patients: How Should Patients Be Counseled?

“…Patients must be informed about the risks of surgical laparoscopy, although surgical laparoscopy is associated with a low rate of complications. Serious complications such as organ injury or secondary bleeding requiring treatment occur in fewer than 1 % of all laparoscopies [27,28]. However, transposition of the ovaries does not protect against the gonadotoxic side effects of chemotherapeutic drugs.…”

“…GnRH analogs are administered up to 2 weeks before the start of chemotherapy as well as during chemotherapy. In addition to ovarian suppression, GnRH analogs administered to patients with hormone receptor-positive breast cancer also have an inhibitory effect on tumor cell growth [28]. Patients with hormone receptor-expressing breast cancer should therefore be informed about the benefits of treatment with GnRH analogs and their limited side effects.…”