Skip to Main Content

CASE HISTORY

Case History

image A 31-year-old woman, with a previous history of radical trachelectomy (RT) secondary to a diagnosis of stage 1B1 cervical cancer (revised FIGO criteria, 2008) was reviewed in the Assisted Conception Unit. This fertility preserving surgery was preferred to a hysterectomy in view of her young age at diagnosis. She had been trying to conceive with her partner for 2 years. She stopped her contraceptive pill in an attempt to conceive naturally, but remained amenorrhoeic; this was previously attributed to her progesterone-only pill. Her transvaginal ultrasound scan revealed polycystic ovaries. Her male partner had a normal semen analysis.

In view of her anovulatory polycystic ovary syndrome (PCOS), she was commenced on ovulation induction medication—clomiphene. The first cycle confirmed evidence of ovulation, and she was recommended to continue with this treatment. However, she remained amenorrhoeic with gradually increasing cyclical pelvic pain. A repeat pelvic scan, 3 months later, identified a retroverted uterus with a distended cavity filled with blood suggesting a haematometra. At hysteroscopy a copious amount of old blood was released. The procedure was noted to be difficult due to complete occlusion of the isthmus making entry to the uterine cavity challenging. Failing to conceive after ovulation induction, in-vitro fertilization (IVF) was recommended. This resulted in four embryos available for transfer. Embryo transfers were challenging due to access to the cavity and required trans-myometrial transfers. No pregnancy was sadly achieved after three consecutive embryo transfer cycles. After the third frozen cycle another hysteroscopy was recommended to re-assess the cavity. The procedure confirmed the presence of cervical stenosis and also uterine adhesions which were resected. A brachytherapy sleeve was inserted at the same time to attempt to prevent reocclusion of access to the uterine cavity. Although advised to seek surrogacy as an alternative route of completing the family, the couple opted to have one more IVF transfer. This resulted in a pregnancy, but at 23 weeks of gestation, preterm delivery took place secondary to chorioamnionitis.

What are the chances of fertility following radical trachelectomy?

What are the challenges associated with cervical stenosis and fertility?

How did this patient’s comorbidities affect her fertility treatment and outcome?

Role of additional cervical stitch in patients with previous trachelectomy

What are the chances of fertility following radical trachelectomy?

With advances in screening, the number of women diagnosed with early stage cervical cancer during child-bearing age has been increasing.1 Annually in the UK, over 1000 women with cervical cancer will present before the age of 45 years warranting clinicians to provide curative but less morbid treatments, with the added benefits of being fertility sparing. With similar long-term oncological outcomes reported with RT and conventional hysterectomy for early-stage cervical cancer, there is increasing emphasis on fertility-sparing treatments.2,3 Xu et al.3 compared cancer recurrence following these two approaches; there was no statistical difference in recurrence rate (5.8% for RT vs. 4.4% for radical ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.