Infertility after abdominal trachelectomy

Abstract

In spite of efforts to preserve fertility, some patients have severe complications after trachelectomy, such as Asherman's syndrome, resulting in infertility. Clinicians should pay careful attention to the status of the endometrial cavity after trachelectomy.

Abdominal cerclage in a patient with a neocervix with planned cesarean hysterectomy at delivery

“…Of 436 reported cases of pregnancy after fertility sparing surgery nearly 67% resulted in live birth, 26% were preterm and 10% had a second trimester spontaneous abortion – twice as high as the general population 9 . In a study of 173 patients who had underwent radical abdominal trachelectomy, there was a total of 25 pregnancies with a conception rate of 22% 10 . Pregnancy rates after trachelectomy varies, including 55–70% after vaginal trachelectomy and lower rates for abdominal trachelectomy, possibly as a result of a wider resection of the uterine artery with the abdominal approach 10 .…”

“…In a study of 173 patients who had underwent radical abdominal trachelectomy, there was a total of 25 pregnancies with a conception rate of 22% 10 . Pregnancy rates after trachelectomy varies, including 55–70% after vaginal trachelectomy and lower rates for abdominal trachelectomy, possibly as a result of a wider resection of the uterine artery with the abdominal approach 10 . Cervical stenosis was a major complication for these pregnancies with a rate of 9.5–15% 10 …”

Survey of the desire to have children and engage in sexual activity after trachelectomy among young Japanese women with early‐stage cervical cancer

“…In our institution, a key eligibility criterion for trachelectomy is a strong desire to have children prior to surgery. However, the trachelectomy procedure can cause cervical stenosis, vaginal scarring, menstrual disruption and pelvic abscess . As a result, even if a strong desire to have children exists before surgery, these complications may result in the absence of the desire to give birth naturally, accompanied by decreased sexual activity.…”

“…Infertility after trachelectomy is a critical problem for patients who desire to have children. We previously reported that 14 of 37 patients who underwent fertility treatment had Asherman's syndrome after trachelectomy . Asherman's syndrome results in infertility, and these patients cannot have children due to the prohibition of surrogate conception in Japan.…”

Abnormal menstruation after radical trachelectomy and its effects on fertility

“…A recent study reported that some patients with menstrual abnormalities after abdominal trachelectomy had Asherman syndrome . Asherman syndrome is a disease that produces partial or complete adhesions in the uterine cavity and/or the cervical canal.…”