Introduction/Background To assess the desire for motherhood, reproductive and obstetric outcomes in young patients with early cervical cancer treated with fertility-sparing surgery (FSS).

Methodology All women ≤ 45 years who underwent FSS for early cervical cancer (stages IA1-IB1) at NN Alexandrov National Cancer Centre of Belarus between January 2010 and December 2020 were retrospectively identified. Fertility-sparing options included cold knife conization (CKC) in 46 patients, CKC and pelvic lymph node dissection (PLND) – in 12, abdominal radical trachelectomy (ART) – in 46, and laparoscopic radical trachelectomy (LRT) – in 12. Data on reproductive intentions and fertility outcomes were reviewed from medical records and questionnaires.

Results A total of 116 patients were analyzed. Six patients after CKC lacked data on obstetric outcomes and 3 had amenorrhea after ART. Reproductive outcomes were studied in 107 patients. Follow-up time was a median of 50.8 months (range,16.4–92.7). During follow-up 46 out of 107 (43.0%) patients attempted to conceive. All 14 pregnancies in 11 patients were achieved spontaneously, clinical pregnancy rate was 23.9% (11/46). While there were 2 first trimester spontaneous abortions, 2 pregnancies ended in the first trimester due to a missed abortion, and 1 ended an ectopic tubal pregnancy, and two pregnancies are ongoing. Seven of 14 pregnancies (50.0%) resulted in live births born at term. All deliveries (7) are noted in patients whom CKC or CKC and PLND were performed.

Conclusion Less than half (43.0%) of the cohort maintained reproductive intent after FSS. All conceptions were spontaneous and occurred in 23.9%, which reflects the need for widespread use of assisted reproductive technologies in this category of patients. In terms of reproductive outcomes, CKC had clear advantages of a less invasive surgical approach compared to ART and LRT.