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.