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Fertility-sparing surgery and fertility preservation in cervical cancer: the desire for parenthood, reproductive and obstetric outcomes.
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  • Rosalie van der Plas,
  • Annelies Bos,
  • Ina Jürgenliemk-Schulz,
  • Kees Gerestein,
  • Ronald Zweemer
Rosalie van der Plas
University Medical Center Utrecht Imaging Division

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Annelies Bos
University Medical Center Utrecht
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Ina Jürgenliemk-Schulz
University Medical Centre Utrecht
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Kees Gerestein
UMC Utrecht
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Ronald Zweemer
University Medical Centre Utrecht
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Objective to evaluate the desire for parenthood and reproductive outcomes following fertility-sparing treatment for invasive cervical cancer including Vaginal Radical Trachelectomy (VRT), Radical Hysterectomy (RH) and chemoradiotherapy. Design Retrospective cohort study Setting Tertiary referral center in the Netherlands Population patients <45 years with invasive cervical cancer desiring to maintain reproductive potential. Methods Clinicopathologic and reproductive outcomes were retrieved from medical files and postal questionnaires for patients treated between 2009 – 2020. Main outcome measures Survival, recurrences, fertility and pregnancy outcomes Results 75 patients were identified of whom 34 underwent VRT, 9 RH and 32 had (chemo)radiotherapy. 26 patients started fertility preservation (FP) procedures of whom 23 (88.5%) successfully preserved fertility. After a median follow-up of 49 months, 5 patients developed recurrent disease and died. Reproductive outcomes were available for 58 patients of whom 89.6% maintained their desire for parenthood. Following VRT, 15 patients conceived 21 pregnancies which resulted in 15 live-births, yielding a pregnancy rate of 61.9% and live-birth rate of 75.0%. Following RH or (chemo)radiotherapy, 3 surrogate pregnancies were established (21.4%) using frozen-thawed oocytes (n=2) and ovarian tissue fragments (n=1) with good neonatal outcomes. Conclusions Many cervical cancer patients maintain the desire to become parents after cancer treatment. Vaginal Radical Trachelectomy and Fertility Preservation enable young women with invasive cervical cancer to become a parent after cancer treatment. Structural and timely fertility counseling is of the essence when attempting fertility-sparing treatment and should be available to all. Keywords cervical cancer / oncofertility / trachelectomy / fertility preservation / surrogacy