Fertility and rate of pregnancies after radical vaginal trachelectomy (RVT)

Objective:

RVT offers young patients with early cervical cancer the possibility of fertility preservation. Besides oncologic outcome pregnancy rate and course of pregnancies are of utmost importance.

Methods:

Retro- and prospective analysis of all patients of the German Uterus VI-study (n=100) and 46 patients operated after study recruitment concerning their reproductive outcome.

Results:

Since 05/2005 146 patients have been followed up after RVT. The mean age at RVT was 35.1 [21;48] years of age. Of these patients only 46 (31.5%) reported an acute desire to have children.

Altogether, 36 pregnancies occurred in 32 women (32/46, 69, 5%). The mean time between RVT and pregnancy was 15.4 [5; 24] months. Patients tried 2.6 [1; 11] months on average to get pregnant.

From the patients who became pregnant, one patient suffered from an ectopic pregnancy. Two patients had a first trimester miscarriage (2/36, 6%), two patients had a second trimester miscarriage (2/36, 6%). Two patients had a pregnancy termination (2/36, 6%).

Only five of our patients needed assisted reproduction: 4 patients had hormone therapy, one patient IVF.

26 children were born via primary caesarean section. Of those, 1 (4%) delivered prematurely before 28 weeks of gestation. 10 (38%) delivered between 28 and 36 weeks and 14 (54%) reached full term. Three pregnancies are ongoing.

Conclusion:

RVT allows a high pregnancy rate. The percentage of miscarriages is increased compared to general population. High risk prematurity (below 28 weeks) is fortunately rare. Our data can help to counsel patients with early stage cervical carcinoma who wish to become pregnant in future.

cervical cancer - fertility - pregnancy - trachelectomy