Radical hysterectomy and chemoradiotherapy
For patients requiring radical hysterectomy or (chemo)radiotherapy,
biological parenthood is only feasible through ART and surrogacy.
Pre-treatment fertility preservation requires close collaboration of
both gynecological-oncologists, reproductive specialists and radiation
specialists to minimize delay in starting cancer treatment. In our
cohort, all patients requiring (chemo)radiotherapy received
pre-treatment fertility counseling and fertility was preserved in 23
patients (88.5%), These results suggest that the structural
implementation of oncofertility services is feasible in a
multidisciplinary oncofertility center. As maintaining fertility
potential is of utmost importance in young patients with cervical
cancer, we advocate the implementation of a well-integrated
oncofertility care program in all centers treating young cancer
patients. To minimize delay in cancer treatment, we believe that efforts
should be made to perform fertility counseling within one week after
diagnosis. Furthermore, we emphasize the importance of weighing in the
possible delay of FP in patients with high-risk disease and feel that an
individualized risk assessment regarding oncological safety should be
carefully evaluated for each patient.
Gestational surrogacy is considered to be a good reproductive option for
patients without a (functional) uterus with an ongoing pregnancy rate of
66.7%25.We report a live-birth rate of 21.4% among
the women who started gestational surrogate treatments. Barriers
explaining this discrepancy include the challenge of finding a suitable
gestational carrier who is approved by the regulations in centers
performing surrogate treatments 25. The process of
finding a gestational carrier is additionally complicated by the Dutch
law, that prohibits commercial surrogacy and the public search for a
surrogate. Lastly, the chance of achieving a biological genetic
offspring may be additionally complicated as some patients may fail to
preserve oocytes leaving OTC as only option to preserve fertility.
Restoration of ovarian function after frozen-thawed ovarian cortex
fragments is achieved in 25 – 30%, resulting in over 130 live-births
worldwide 26, 27. However, this procedure is still
considered experimental in the Netherlands. We report only one birth in
our cohort after auto-transplantation of frozen-thawed ovarian tissue
fragments in an experimental setting. As this may be the only option for
patients who cannot delay cancer treatment or fail to preserve oocytes,
we do support to continue using this technique.
We expect that the number of surrogate pregnancies in our cohort is
likely to increase, as 7 patients are still searching for a gestational
carrier and one patient found a gestational carrier for which she
currently is within fertility treatments.