title: Fertility results and pregnancy outcomes after conservative treatment of cervical cancer: a systematic review of the literature.
abstract: OBJECTIVE
  To evaluate the fertility results, obstetric outcomes, and the management of infertility in patients submitted to fertility-sparing surgery (FSS) for invasive cervical cancer.
  
  
  METHODS
  Systematic review.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Patients submitted to FSS for invasive cervical cancer (stage IB).
  
  
  METHODS
  Five different FSS procedures were studied.
  
  
  METHODS
  Fertility, pregnancy outcomes, and management of infertility.
  
  
  RESULTS
  A total of 2,777 patients submitted to FSS and 944 ensuing pregnancies were included in this review. Five different surgical procedures were performed and studied. The overall fertility, live birth, and prematurity rates after these procedures were, respectively, 55%, 70%, and 38%. The pregnancy rate was higher in patients submitted to a vaginal or minimally invasive radical trachelectomy compared with a laparotomic radical trachelectomy. The live birth rate was similar, whatever the FSS procedure. The prematurity rate was significantly lower in patients who had undergone a simple trachelectomy/cone resection and neoadjuvant chemotherapy followed by FSS compared with other conservative surgeries. A majority of second trimester fetal losses and premature deliveries were related to premature rupture of membranes.
  
  
  CONCLUSIONS
  The choice between the different FSS procedures depends first and foremost on the oncologic characteristics of the tumor. Nevertheless, when several options seem to offer the same oncologic results (for example, stage IB1 disease >2 cm), fertility results should then be taken into consideration to select the best choice acceptable to the patient/couple.
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Enrica
authors.initials: E
authors.lastname: Bentivegna
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Amandine
authors.initials: A
authors.lastname: Maulard
authors.affiliation: Department of Medical Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.affiliation: Department of Radiation Oncology, Gustave Roussy, Villejuif, France.
authors.forename: Cyrus
authors.initials: C
authors.lastname: Chargari
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France.
authors.forename: Sebastien
authors.initials: S
authors.lastname: Gouy
authors.affiliation: Department of Gynecologic Surgery, Gustave Roussy, Villejuif, France; Unit Institut national de la santé et de la recherche médicale, Villejuif, France; University Paris Sud, Le Kremlin Bicetre, France. Electronic address: morice@igr.fr.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D005260:Female; D005298:Fertility; D059247:Fertility Preservation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000503:physiopathology / Q000628:therapy; D010535:Laparoscopy / Q000009:adverse effects; D050498:Live Birth; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D011247:Pregnancy; D018873:Pregnancy Rate; D047928:Premature Birth / Q000209:etiology; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects; D000069339:Trachelectomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery*
keywords: Cerclage; conization; conservative treatment; early-stage cervical cancer; fertility; neoadjuvant chemotherapy; preterm delivery; trachelectomy