J Gynecol Oncol.
2019 May;30(3):e45. 10.3802/jgo.2019.30.e45.
Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer
- Affiliations
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- 1Department of Obstetrics, Gynecology, and Reproductive Sciences, The University of Texas Health Science Center at Houston, Houston, TX, USA.
- 2Division of Reproductive Endocrinology and Infertility, Baylor College of Medicine, Houston, TX, USA.
- 3Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. mfrumovitz@mdanderson.org
- KMID: 2440509
- DOI: http://doi.org/10.3802/jgo.2019.30.e45
Abstract
OBJECTIVE
To 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.
METHODS
Patients 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.
RESULTS
Of 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).
CONCLUSION
A 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.
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