PROBLEMS IN REPRODUCTIVE FUNCTION REALIZATION AFTER ORGAN-SAVING TREATMENT FOR CANCER OF THE CERVIX UTERI

Objective. To analyze the reproductive function of patients undergoing organ-saving surgery for intraepithelial and early invasive carcinoma of the cervix uteri (CCU), to assess whether reproductive function can be realized, and to determine management tactics in these women. Subjects and methods. Twelve infertile patients previously operated on for intraepithelial and invasive CCU were followed up. Knife amputation of the cervix uteri was performed in 5 patients with intraepithelial carcinoma. Radical abdominal trachelectomy (RAT) was used in 7 patients with early invasive CCU. Examination involved evaluation of the reproductive system in spouses and estimation of the ovarian reserve in women. Attempts were made in some patients to achieve pregnancy by IVF during a natural cycle or after superovulation. Results. Normal ovarian reserve values were recorded in 6 women aged 31 to 36 years. Three 38- and 40-year-old patients had decreased ovarian reserve values. In 3 women aged 38, 39, and 40 years, the ovarian reserve values were estimated to be extremely low. An IVF program was implemented in 6 promising patients. In one of them, an oocyte was taken in a natural cycle, pregnancy occurred after the second attempt. Five women were superovulated according to a gonadotropin-releasing hormone antagonist-based protocol. Uterine pregnancy occurred in 4 women, which ended in delivery in 1 woman after high knife amputation of the cervix uteri. In 3 other women (2 patients after RAT and 1 after knife amputation of the cervix uteri), their pregnancies were interrupted at 18, 20, and 24 weeks. Conclusion. Half of the women who have asked to be treated for infertility after organ-saving treatment for CCU are unpromising for IVF pregnancy. Successful realization of reproductive function calls for a close collaboration of oncogynecologists and reproductologists who jointly determine a management tactic in each specific case.

carcinoma of the cervix uteri, ovarian reserve, radical abdominal trachelectomy, in vitro fertilization, reproductive losses