Outcomes of fertility treatment after radical trachelectomy for early stage cervical cancer

Abstract

Background Perinatal outcomes including miscarriage, chorioamnionitis, preterm premature rupture of membranes, and premature birth in patients who undergo radical trachelectomy (RT) are correlated with cervical stenosis, bleeding, and shortening; infertility treatment is necessary, and a relatively high proportion of patients achieve pregnancy post-RT. A decreased response to ovarian stimulation in in vitro fertilization (IVF) and decreased pregnancy rates per embryo transfer (ET) have been reported in patients post-RT. This study aimed to investigate clinical characteristics and IVF outcomes of patients post-RT. Results This retrospective cohort study included 41 patients who underwent IVF among 297 individuals who underwent RT for early-stage cervical cancer between January 2009 and December 2022. Participants were referred to our reproductive center for IVF after undergoing RT for early-stage cervical cancer at our gynecology department at Keio University. All patient medical records were analyzed for the following variables: tumor characteristics, postoperative treatment, intraperitoneal infection post-surgery, age at operation and initial oocyte retrieval, body mass index, serum anti-Müllerian hormone level, ovarian stimulation protocol, gonadotropin dose, trigger type, number of oocytes retrieved and cryopreserved, fertilization rate, number of frozen embryos, pregnancy outcomes, presence of cervical stenosis and cervical dilation, endometrial thickness at ET, and Towako® method utilization. Of 41 patients who underwent IVF, 68% achieved clinical pregnancies with 59% live births. Age at initial oocyte retrieval and number of oocytes retrieved were significantly different between clinical-pregnancy and non-clinical pregnancy groups and between live-birth and non-live birth groups. The live-birth group had fewer cases of cervical stenosis. Endometrial thickness at ET was also significantly different between live-birth and non-live birth groups, with an optimal 9.2-mm threshold for predicting pregnancy and live birth and an additional 7.5-mm threshold for live births. Conclusions Age at initial oocyte retrieval, endometrial thickness at ET with an optimal 9.2-mm threshold for predicting pregnancy and live birth and an additional 7.5-mm threshold for live births, and presence of cervical stenosis are factors potentially influencing IVF outcomes post-RT. These findings may serve as a reference for considering IVF post-RT and support the use of endometrial thickness as a predictive marker in assisted reproductive technology.