Introduction/Background The goal of fertility-sparing treatment (FST) for patients with cervical cancer is to achieve comparable oncologic outcomes to those after radical treatment while maximizing reproductive outcomes, which include the ability to conceive and minimizing the risk of preterm birth.
Methodology Patients from the international multicentre retrospective FERTISS study, which included women treated with any type of FST, were analysed for information on timing of FST in relation to pregnancy, attempts to conceive, mode of conception, prophylactic procedures to reduce the risk of severe prematurity, rate of pregnancy failure, overall duration of pregnancy and mode of termination.
Results Of the 733 patients treated at 44 centres in 13 countries, only half (49.7%) attempted to become pregnant during follow-up (median 72 months). Unsuccessful attempts were recorded in 27.0% (198/733) of patients, while 22.6% (166/733) were successful. Of these patients, 63.2% (122/193) underwent non-radical surgery and 25.7% (44/171) underwent radical trachelectomy (p < 0.001). Data from 124 patients (74.7%) were available for detailed analysis. A total of 91.7% (111/124) patients became pregnant naturally. The abortion rate in the first pregnancy did not differ between patients after radical and non-radical procedures. There was no difference in delivery success rates between patients after non-radical and radical FST (86% vs. 83%, p=0.77). Preterm delivery (<38 weeks gestation) occurred more frequently in patients after radical than non-radical procedures (76.5% vs. 57.7%, p=0.15). Almost all patients (97.3%) with ultrasound cervicometry delivered, in contrast to women without cervicometry (30.6%), (p<0.001).
Conclusion Half of the patients did not attempt pregnancy at all after FST. Patients who underwent non-radical surgery had higher pregnancy rates. Most women who became pregnant delivered a viable fetus, but women who underwent radical trachelectomy had a higher rate of preterm births in the severe prematurity range. Ultrasound cervicometry showed a significant effect on the prevention of preterm birth.
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