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Hum. Reprod. Advance Access originally published online on December 18, 2008
Human Reproduction 2009 24(4):876-879; doi:10.1093/humrep/den457
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© The Author 2008. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Assisted conception following radical trachelectomy

I. Wong1, W. Justin, S. Gangooly, L. Sabatini, T. Al-Shawaf, C. Davis, A. Zosmer and A. Tozer

Centre for Reproductive Medicine, St Bartholomew's Hospital, Barts and The London NHS Trust, Kenton and Lucas Wing, London EC1A 7BE, UK

1 Correspondence address. E-mail: ismailwong{at}aol.com

BACKGROUND: Radical trachelectomy (RT) has been established as a valuable fertility-preserving treatment in women with early stage cervical cancer. A number of these women will require assisted conception which may bring certain challenges to those managing treatment. An awareness of those challenges is essential to maximize outcome in terms of live birth rates.

METHODS: All women who had undergone assisted conception following RT were assessed with respect to treatment management and pregnancy outcome.

RESULTS: Pregnancy rates were good, with nine pregnancies in seven women treated. Difficulties in treatment were essentially related to isthmic stenosis. There was a clear need for trial embryo transfer (ET) prior to treatment and dilatation of the isthmus where necessary. The premature delivery rate was high (75% at <37 weeks), highlighting the importance of single ET to avoid multiple pregnancy.

CONCLUSIONS: Assisted conception following RT is associated with a good pregnancy rate, although there is a high miscarriage and premature delivery rate. Treatment outcome should be maximized by careful patient preparation in terms of assessing the need for isthmic dilatation, and ET should be performed by an experienced operator.

Key words: radical trachelectomy/embryo transfer/isthmic dilatation/cervical cancer/IVF

Submitted on July 29, 2008; resubmitted on October 29, 2008; accepted on October 31, 2008.


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