title: Gestational trophoblastic disease.
abstract: Most women with gestational trophoblastic disease are of reproductive age. Because the disease is readily treatable with favourable prognosis, fertility becomes an important issue. Hydatidiform mole is a relatively benign disease, and most women do not require chemotherapy after uterine evacuation. A single uterine evacuation has no significant effect on future fertility, and pregnancy outcomes in subsequent pregnancies are comparable to that of the general population, despite a slight increased risk of developing molar pregnancy again. If women develop persistent trophoblastic disease, single or combined chemotherapy will be needed. Although ovarian dysfunction after chemotherapy is a theoretical risk, a term live birth rate of higher than 70% has been reported without increased risk of fetal abnormalities. Successful pregnancies have also been reported after choriocarcinoma. Only a few case reports have been published on fertility-sparing treatment in placental-site trophoblastic tumour, and the successful rate is about 67%. Women are advised to refrain from pregnancy for at least 6 months after a molar pregnancy, and at least 12 months after a gestational trophoblastic neoplasia. Most of the contraceptive methods do not have an adverse effect on the return of fertility. Finally, at least one-half of these women suffer from some form of psychological or sexual problems. Careful counselling and involvement of a multi-disciplinary team are mandated.
authors.affiliation: Department of Obstetrics and Gynaecology, Queen Mary Hospital, the University of Hong Kong, Hong Kong. tseky@hkucc.hku.hk
authors.forename: K Y
authors.initials: KY
authors.lastname: Tse
authors.forename: Hextan Y S
authors.initials: HY
authors.lastname: Ngan
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D003267:Contraception; D004107:Dilatation and Curettage; D005260:Female; D059247:Fertility Preservation; D031901:Gestational Trophoblastic Disease / Q000150:complications / Q000523:psychology / Q000628:therapy*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000517:prevention & control; D009364:Neoplasm Recurrence, Local / Q000628:therapy*; D059351:Organ Sparing Treatments; D010053:Ovary / Q000187:drug effects / Q000503:physiopathology; D011247:Pregnancy; D011256:Pregnancy Outcome
chemical_list: D000970:Antineoplastic Agents