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Approximately 43 percent of all cervical cancers diagnosed are in women under the age of 45. Although the average age for women to develop cervical cancer is when they are in their 30's, unfortunately there are times when HPV (human papillomavirus) results in cervical cancer in even younger women in their 20's. In either case, with many women now putting off having children until a later age, either group can find themselves facing treatment which may put an end to their fertility.
While many physicians routinely perform a hysterectomy in cases of cervical cancer where appropriate, for many women there is another option and one which spares one’s fertility – the VRT or vaginal radical trachelectomy.
This procedure was introduced in the 1990’s by Dr. Daniel Dargent of Lyon, France. Other physicians, particularly those in the U.S., laughed at Dargent who is now seen as a hero, and despite 15 years of documentation regarding the procedure and the live births which have resulted, it is exceedingly difficult for a woman to find a doctor who is trained to perform this procedure.
According to Dr. Joel Sorosky, of the University of Iowa Hospitals and a member of the ACOG scientific program committee, of the cases of cervical cancer diagnosed each year, 70 to 75 percent are stage one lesions. Aside from the women in this group who are older and not concerned with fertility, a large percentage of these patients are good candidates and could benefit from the trachelectomy procedure.
The patient must meet certain criteria, part of which includes that there be no lymph node involvement and the likelihood of recurrence is small. In addition, delivery must be performed via a Caesarean section and there is an increased risk of miscarriage. However, for those desperate to have a family, it is worth the risk.
The procedure itself involves entrance through the vagina as opposed to the abdomen. Although it can be performed through abdominal incision the vaginal procedure reduces another potential site of infection post surgery. The cervix is totally removed along with a portion of the lower uterus and upper vagina. The ovaries are preserved and the remaining uterus is then sutured to the vaginal vault.
The procedure has been shown to have a shorter recovery time than a hysterectomy, is less painful and is just as effective in treating cervical cancer as a hysterectomy. Hopefully more doctors will become trained in this procedure in order to provide women the option of retaining their fertility. Meanwhile, women should know about this procedure because if your doctor does not perform it, he may not mention it as an option – something I have been told by many women. For those wanting children it is a very important procedure to know about.
http://www.medscape.com/viewarticle/453234
http://www2.mdanderson.org/depts/oncolog/articles/08/6-jun/6-08-2.html
http://www.ncbi.nlm.nih.gov/pubmed/10760765
http://www.umm.edu/patiented/articles/what_specific_treatments_cervical_intraepithelial_neoplasia_cin_000046_9.htm
http://www.uwhealth.org/uw-carbone-cancer-center/trachelectomy-cervicectomy/10985
Reviewed May 25, 2011
Edited by Alison Stanton
Add a Comment2 Comments
I don't believe any fertilty studies would have included women having had trachelectomies in their statistics as this would have falsely elevted the risks of premature birth since a trachelectomy already carries that risk.
July 7, 2011 - 8:30amThe procedure involves removal of the cervix with a cerclage (suturing) closed of the remaining orafice. It allows for conception but obviously does not provide the support that a cervix would.
The study link below indicates about half of all women having had trachelectomies have tried to conceive with a 75% success rate and 60 percent having full term infants. Therefore the likelihood of premature infants would be 40%. This is only one article however so researching other articles may provide slightly differing results. Also the criteria is very strict when choosing those who are eligible to have the procedure which is explained in more detail in this article. I hope you find it helpful.
http://www2.mdanderson.org/depts/oncolog/articles/08/6-jun/6-08-2.html
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Thank you very much for sharing this information. I had not heard of this procedure and find it very interesting. I'll follow-up to learn more.
I would like to ask you a couple of questions. You mentioned there is a risk of miscarriage, once you are pregnant. Can you clarify what that risk is? Is there a percentage?
There are several studies in existance which link infertility treatment to premature births. I am wondering if those studies took into consideration how many women had also undergone procedures to treat cervical conditions such as HPV. Perhaps those treatments lead to complications such as an incompetent cervic rather than infertility treatment.
I am wondering your thoughts on this.
Thank you,
Davina
Davina Fankhauser
July 6, 2011 - 1:34pmFertility Within Reach
www.fertilitywithinreach.org
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