Reproductive counseling and pregnancy outcomes after radical trachelectomy for early stage cervical cancer

J Gynecol Oncol. 2019 May;30(3):e45. doi: 10.3802/jgo.2019.30.e45.


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.

Keywords: Cervical Cancer; Fertility Preservation; Pregnancy; Radical Trachelectomy; Reproductive Counseling.

MeSH terms

  • Adenocarcinoma / epidemiology
  • Adenocarcinoma / pathology
  • Adenocarcinoma / surgery
  • Adult
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / surgery
  • Counseling* / methods
  • Counseling* / statistics & numerical data
  • Cross-Sectional Studies
  • Female
  • Fertility Preservation / methods
  • Fertility Preservation / psychology
  • Fertility Preservation / statistics & numerical data
  • Humans
  • Neoplasm Staging
  • Perception
  • Postoperative Complications / epidemiology
  • Postoperative Complications / psychology
  • Pregnancy
  • Pregnancy Complications, Neoplastic / epidemiology
  • Pregnancy Complications, Neoplastic / surgery
  • Pregnancy Outcome / epidemiology*
  • Retrospective Studies
  • Trachelectomy* / adverse effects
  • Trachelectomy* / statistics & numerical data
  • Uterine Cervical Neoplasms / epidemiology
  • Uterine Cervical Neoplasms / pathology
  • Uterine Cervical Neoplasms / surgery*