Reproductive outcomes following treatment for a gynecological cancer diagnosis: a systematic review

Abstract

Purpose: Fertility treatments are available for women diagnosed with a gynecological malignancy, which is important for women who desire a biological family subsequent to treatment. The objective of this study was to report reproductive outcomes following fertility-sparing treatment for a gynaecological cancer.

Methods: Electronic databases were searched to identify studies that reported on reproductive outcomes after treatment for a gynecological malignancy.

Results: In total, 77 studies were included which reported on reproductive outcomes after treatment for cervical cancer, endometrial cancer, gestational trophoblastic disease, and ovarian cancer. The main treatments included vaginal or abdominal radical trachelectomy, progestin therapy, salpingo-oophorectomy, and chemotherapy. The mean age at diagnosis for the study population and at birth were 30.5 years and 30.3 years, respectively. There were 4749 pregnancies (42%) reported for the included studies, with a miscarriage rate of 15% and a medical termination rate of 5%. The live birth rate was 74% with a 10% preterm rate.

Implications for cancer survivors: Patients should be offered timely discussions, information, and counseling regarding the impact of gynecological cancer treatment on a patient's fertility. Furthermore, fertility-sparing strategies and fertility preservation should be discussed prior to starting treatment.

Keywords: Gynecological neoplasms; Oncofertility; Pregnancy; Survivors; Systematic review.