Assisted conception following radical trachelectomy.
BACKGROUND
Radical trachelectomy (RT) has been established as a valuable fertility-preserving treatment in women with early stage cervical cancer. A number of these women will require assisted conception which may bring certain challenges to those managing treatment. An awareness of those challenges is essential to maximize outcome in terms of live birth rates.


METHODS
All women who had undergone assisted conception following RT were assessed with respect to treatment management and pregnancy outcome.


RESULTS
Pregnancy rates were good, with nine pregnancies in seven women treated. Difficulties in treatment were essentially related to isthmic stenosis. There was a clear need for trial embryo transfer (ET) prior to treatment and dilatation of the isthmus where necessary. The premature delivery rate was high (75% at <37 weeks), highlighting the importance of single ET to avoid multiple pregnancy.


CONCLUSIONS
Assisted conception following RT is associated with a good pregnancy rate, although there is a high miscarriage and premature delivery rate. Treatment outcome should be maximized by careful patient preparation in terms of assessing the need for isthmic dilatation, and ET should be performed by an experienced operator.
Wong
I
I
Centre for Reproductive Medicine, St Bartholomew's Hospital, Barts and The London NHS Trust, Kenton and Lucas Wing, London EC1A 7BE, UK. ismailwong@aol.com
Justin
W
W
Gangooly
S
S
Sabatini
L
L
Al-Shawaf
T
T
Davis
C
C
Zosmer
A
A
Tozer
A
A
D000328:Adult; D002404:Catheterization; D002985:Clinical Protocols; D003251:Constriction, Pathologic; D004106:Dilatation; D004624:Embryo Transfer; D005260:Female; D005298:Fertility; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008197:Lymph Node Excision; D011247:Pregnancy; D011256:Pregnancy Outcome; D027724:Reproductive Techniques, Assisted; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014599:Uterus / Q000473:pathology; D055815:Young Adult