Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer

Abstract

ObjectiveTo evaluate patient perceptions of preoperative reproductive counseling and to evaluate complications and pregnancy outcomes in women who had radical trachelectomy (RT) for early stage cervical cancer.MethodsPatients who underwent RT from January 1, 2004, through July 31, 2017, and had been cancer free for more than 1 year after RT were eligible; consented patients were sent a 16-item online survey.ResultsOf the 58 eligible patients, 39 patients (67%) completed the questionnaire. Eighteen patients (46%) reported receiving reproductive counseling and 26 (68%) reported receiving counseling about pregnancy risks and complications prior to RT, mainly delivered by gynecologic oncologists. Twenty-nine patients (74%) reported having a complication after RT, and cervical stenosis was the most common complication, occurring in 13 patients (33%). Twenty-four patients actively attempted to conceive after RT, and 20 pregnancies were achieved in 13 patients for a pregnancy rate of 54%. Eight pregnancies were spontaneous and 12 required a fertility treatment. There were 5 spontaneous first-trimester miscarriages; 14 of the 20 pregnancies (70%) resulted in live births. The median time to conception was 13.5 months (range, 1–120).ConclusionA significant proportion of women with early stage cervical cancer do not receive adequate reproductive counseling before RT, and many women undergoing RT experience complications that can negatively impact their fertility. We recommend a preoperative consultation with a reproductive endocrinologist for all patients considering RT.

Abdominal radical trachelectomy as fertility‑sparing management for early stages of cervical cancer: Our experience in 18 cases

“…Preoperative counseling regarding unfavorable obstetrical outcome is very important and can also help to set realistic expectations regarding pregnancy. In order to correctly identify the cause of infertility after ART, a preoperative assessment of the reproductive capability (ovarian reserve, ovulatory dysfunction or tubal factor) is recommended by a reproductive specialist ( 27 ). ART is a demanding technique; thus, it is advisable for this procedure to be performed only at oncologic departments with high expertise in cervical cancer surgery, that are extremely familiar in performing radical hysterectomies ( 28 ).…”

Cervical stenosis and pregnancy rate after ultrasound guided cervical dilation in women undergoing saline infusion sonography

“…Cervical stenosis is typically considered as a factor that may lead to infertility in women who have had surgery for cervical intraepithelial neoplasia (CIN) ( 9 ) . However, it can also be a culprit in cases where no such history is present.…”

Successful Term Pregnancy Following Radical Trachelectomy and Laparoscopic Lymphadenectomy in a Patient with Invasive Cervical Squamous Cell Carcinoma: The First Case Reported from Iran

“…Although there were no pregnancy complications in our patient, the increased risk of pregnancy complications has to be fully explained to the patient, before she decides on the conception and the patient should be advised to refer frequently for the follow-up and follow the instructions carefully (10), as we did for the patient. Pre-operative obstetric consultation for a better pregnancy outcome in patients candidate of RT also have been suggested (13). According to the experience, we believe that appropriate obstetric care in addition to appropriate surgical strategies can result in favorable obstetric outcome after VRT, although the tumor stage and underlying diseases of the patient also play an important role.…”