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Fertility outcomes following surgery and multiagent chemotherapy in malignant ovarian germ cell tumor survivors: a survey study
  1. Alice Bergamini1,2,
  2. Ramya Ramaswami1,
  3. Fieke Froeling1,3,
  4. Panos Papanastasopoulos1,
  5. Dee Short1,
  6. Xianne Aguiar1,
  7. Philip M Savage1,4,
  8. Naveed Sarwar1,
  9. Baljeet Kaur1,5,
  10. Srdjan Saso6,
  11. Christina Fotopoulou6,
  12. Anand Sharma7,
  13. Gordon John Sampson Rustin7 and
  14. Michael Seckl1
  1. 1 Department of Medical Oncology, Charing Cross Hospital, London, UK
  2. 2 Department of Obstetrics and Gynecology, San Raffaele Hospital, Milano, Lombardia, Italy
  3. 3 Wolfson Wohl Cancer Research Centre and Beatson West of Scotland Cancer Centre, School of Cancer Sciences, University of Glasgow, Glasgow, UK
  4. 4 Department of Medical Oncology, Brighton and Sussex University Hospitals NHS Trust, Worthing, UK
  5. 5 Department of Histopathology, Charing Cross Hospital, London, UK
  6. 6 Department of Gynecologic Oncology, Hammersmith Hospitals NHS Trust, London, UK
  7. 7 Department of Medical Oncology, Mount Vernon and Watford NHS Trust, Watford, UK
  1. Correspondence to Professor Michael Seckl, Department of Medical Oncology, Charing Cross Hospital, London W6 8RF, UK; m.seckl{at}


Objective To assess fertility outcomes in long-term survivors of malignant ovarian germ cell tumors treated with fertility-sparing surgery with or without additional chemotherapy.

Methods Women diagnosed and treated for malignant ovarian germ cell tumors at Charing Cross Hospital or Mount Vernon Cancer Centre between 1977 and 2015 were included. Questionnaires assessing fertility issues were sent to patients treated with fertility-sparing surgery. Fertility outcomes were evaluated according to the treatment received. The effect of the mean total dose of cyclophosphamide and cisplatin was assessed.

Results A total of 146 patients were sent the questionnaire; 77 (56.5%) patients were included in the analysis. A total of 49 (64%) patients received platinum-based chemotherapy after surgery, 39 (79.6%) of these with cisplatin, vincristine, methotrexate, bleomycin, actinomycin D, cyclophosphamide, and etoposide, while 10 (20.4%) with bleomycin, etoposide, and cisplatin. After any treatment, 39/46 patients (85%) became pregnant: the conception rate was not different between those receiving surgery only and those receiving also chemotherapy (85.7% vs 84.4%, p=1.0). Live birth rate was 80.4% (37/46), with no statistically significant difference between the treatment groups (p=0.42). Median age of women achieving conception was 29 years (IQR 26–33). The probability of live birth at 5 years was 48% and 40% for patients in the surgery only and chemotherapy group, respectively (p=0.55). Infertility and miscarriage rates did not differ significantly between the two treatment groups (p=0.30 and p=0.32). The mean doses of cisplatin and cyclophosphamide received by patients failing and achieving conception were not different (p=0.10, p=0.47).

Conclusions Our results suggest that fertility may not be hampered in patients with malignant ovarian germ cell tumor treated with fertility-sparing surgery or receiving additional chemotherapy.

  • ovarian neoplasms

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • AB, RR and FF contributed equally.

  • Contributors AB, RR, AND FF are joint first co-authors, and contributed equally. Conceptualization: MS, RR, FF, AB; methodology: RR, FF, AB; software: RR, FF; validation: MS, AB, RR, FF; formal analysis: RR, FF; investigation: MS, PP, DS, XA, PMS, NS, AS, GJSR; resources: BK, SS, CF, DS, XA, AS, NS, GJSR, PP, MS; data curation: AB, RR, FF; writing (original draft): AB, FF, RR, MS; writing (review and editing): all authors; visualization: AB, FF, RR; supervision MS. Guarantor: MS.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CF received honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Astrazeneca, GSK, MSD, Tesaro, Clovis, Ethicon.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.