The complexity and challenges of fertility preservation in women with cervix cancer-A prospective cohort study reporting on reproductive outcome and overall survival.

Introduction

Our objective was to assess the feasibility of fertility preservation (FP) in women referred for cervix cancer, the long-term reproductive outcome, and overall survival.

Material and methods

Prospective cohort study of patients referred for FP counseling between 1999 and 2021 to the FP program of Karolinska University Hospital, Stockholm, Sweden. Baseline data included age, parity, disease stage, treatment characteristics, and FP methods applied. Data on reproductive outcomes and overall survival (by October 19, 2023) were retrieved from clinical registries and a population-based register.

Trial registration number

ClinicalTrials.gov NTC04602962.

Results

In total, 91 women were referred, 67% with stage I cancers and 25%, 7%, and 1% with stages II, III, and IV, respectively. Cancers were diagnosed during pregnancy or postpartum in six cases. Cancer treatments included fertility-sparing surgery in 14%, hysterectomy in 30%, and radiochemotherapy in 79% of cases. The treatment modality did not rule out the possibility to undergo FP, and following counseling, 68 patients elected to undergo FP by cryopreservation of embryos or oocytes (N = 11), ovarian tissue (N = 54), or both (N = 3). After a mean follow-up of 8.1 years, 25 women (37%) returned to the center, five women achieved conception either spontaneously or through assisted reproduction, and 11 women became mothers through adoption or surrogacy. In the group of women receiving radical surgery or chemo/radiotherapy, no live births using cryopreserved specimens have yet been achieved. During follow-up, 7 women (10%) in the FP group and 5 women (24%) in the group without FP had died of their disease. Cancer recurrence was documented in 19 patients.

Conclusions

Our findings underscore the complexity and challenges associated with FP in the context of cervix cancer. Results of this study demonstrate that many women diagnosed with cervix cancer at reproductive age desire to achieve parenthood. While fertility-sparing surgery can allow pregnancy, those who undergo a hysterectomy are limited to adoption, surrogacy, or the emerging possibility of uterus transplantation.

References:

• Cancer statistics for the Nordic countries. 2023; https://nordcan.iarc.fr/en/dataviz/tables.
• American Cancer Society. Cancer Facts & Figures. 2024.
• Bruni L, Albero G, Serrano B, et al. Human papillomavirus and related diseases in the world. Summary Report. 2023;10: ICO/IARC Information Centre on HPV and Cancer (HPV Information Centre). https://hpvcentre.net/statistics/reports/SWE.pdf?t=1731354573943; page 9‐11.
• Carter J, Rowland K, Chi D, et al. Gynecologic cancer treatment and the impact of cancer‐related infertility. Gynecol Oncol. 2005;97:90‐95.
• Corney RH, Crowther ME, Everett H, Howells A, Shepherd JH. Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery. Br J Obstet Gynaecol. 1993;100:73‐78.