Brigitte Gerstl1,2, Elizabeth Sullivan3, Marcus Vallejo2, Jana Koch4, Maximilian Johnson5, Handan Wand1, Kate Webber6,7, Angela Ives8, Antoinette Anazodo9,10,11. 1. Department of Biostatistics, The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. 2. Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, 2031, Australia. 3. Australian Centre for Public Health and Population Health Research, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia. 4. Department of Epidemiology, Technical University of Munich, Munich, Germany. 5. Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, UK. 6. Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia. 7. Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia. 8. Cancer and Palliative Care Research and Evaluation Unit, University of Western Australia, Crawley, WA, Australia. 9. Kids Cancer Centre, Sydney Children's Hospital, Sydney, NSW, 2031, Australia. Antoinette.anazodo@health.nsw.gov.au. 10. Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia. Antoinette.anazodo@health.nsw.gov.au. 11. School of Women's and Children's Health, Discipline of Paediatrics, University of New South Wales, Sydney, NSW, Australia. Antoinette.anazodo@health.nsw.gov.au.
Abstract
PURPOSE: Fertility treatments are available for women diagnosed with a gynecological malignancy, which is important for women who desire a biological family subsequent to treatment. The objective of this study was to report reproductive outcomes following fertility-sparing treatment for a gynaecological cancer. METHODS: Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a gynecological malignancy. RESULTS: In total, 77 studies were included which reported on reproductive outcomes after treatment for cervical cancer, endometrial cancer, gestational trophoblastic disease, and ovarian cancer. The main treatments included vaginal or abdominal radical trachelectomy, progestin therapy, salpingo-oophorectomy, and chemotherapy. The mean age at diagnosis for the study population and at birth were 30.5 years and 30.3 years, respectively. There were 4749 pregnancies (42%) reported for the included studies, with a miscarriage rate of 15% and a medical termination rate of 5%. The live birth rate was 74% with a 10% preterm rate. IMPLICATIONS FOR CANCER SURVIVORS: Patients should be offered timely discussions, information, and counseling regarding the impact of gynecological cancer treatment on a patient's fertility. Furthermore, fertility-sparing strategies and fertility preservation should be discussed prior to starting treatment.
PURPOSE: Fertility treatments are available for women diagnosed with a gynecological malignancy, which is important for women who desire a biological family subsequent to treatment. The objective of this study was to report reproductive outcomes following fertility-sparing treatment for a gynaecological cancer. METHODS: Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a gynecological malignancy. RESULTS: In total, 77 studies were included which reported on reproductive outcomes after treatment for cervical cancer, endometrial cancer, gestational trophoblastic disease, and ovarian cancer. The main treatments included vaginal or abdominal radical trachelectomy, progestin therapy, salpingo-oophorectomy, and chemotherapy. The mean age at diagnosis for the study population and at birth were 30.5 years and 30.3 years, respectively. There were 4749 pregnancies (42%) reported for the included studies, with a miscarriage rate of 15% and a medical termination rate of 5%. The live birth rate was 74% with a 10% preterm rate. IMPLICATIONS FOR CANCER SURVIVORS: Patients should be offered timely discussions, information, and counseling regarding the impact of gynecological cancer treatment on a patient's fertility. Furthermore, fertility-sparing strategies and fertility preservation should be discussed prior to starting treatment.
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