Why getting pregnant after cervical cancer needn’t be a struggle

It is believed that the most frequent gynaecological cancer discovered during pregnancy is cervical cancer. According to few studies, the incidence rates of cervical cancer range from 0.1 to 12 per 10,000 pregnancies. 

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A diagnosis of cervical cancer is overwhelming and may be associated with worries about how it will impact your ability to conceive. While some cervical cancer treatments can harm fertility, there are options to help protect your ability to become pregnant after treatment. The management of cervical cancer requires a range of multimodal treatments. Fertility may suffer as a result of some these therapies, so let's take a closer look at the potential effects of various treatments on fertility: 

Surgery: The uterine body is connected to the vagina by the cervix, which is the bottom portion of the uterus. Cervical cancer can treated with many forms of surgery. The uterus and cervix, for instance, might be removed. Since a fetus or developing baby, grows and lives inside the uterus, it's not feasible to carry a pregnancy when both the uterus and cervix are removed.

Radiation therapy: This may be administered to the pelvic region where cervical cancer is diagnosed in certain patients. Fertility may be impacted if it damages the ovaries and uterus and impairs their capacity to function.

Chemotherapy: Reproductive organs are harmed by certain chemotherapy (chemo) medications used to treat cervical cancer. Fertility may be impacted if this results in early menopause. Patients who are taking large doses of one or more of these chemo medicines are especially at risk for this. 

That said, let me hurry to add that it is possible for women to become pregnant after being diagnosed with cervical cancer.  A 2020 study, Fertility-Sparing Treatment for Early-Stage Cervical, Ovarian, and Endometrial Malignancies, for instance, discovered that almost half of the patients who underwent fertility-sparing surgery, and subsequently, attempted to conceive were successful in becoming pregnant. It is paramount to understand that receiving a cervical cancer diagnosis does not preclude you from becoming a parent. However, it truly depends on the disease's stage, severity, and intended course of treatment. 

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Choices for preserving fertility 

Women diagnosed with cervical cancer have a number of alternatives for preserving their fertility. For instance, trachelectomy and conization – procedures that preserve fertility – may be an option for certain individuals. In these surgeries, the entire cervix or a part of it is taken out, while retaining the uterus. This form of treatment helps preserve the patient's   capacity to carry a pregnancy. 

In circumstances where fertility-sparing surgery may not prove feasible, there are alternative preservation techniques. These include the freezing of eggs and embryos. These operations are typically safe to do prior to the start of cancer treatment. Additionally, ovarian transposition may be a possibility for patients undergoing radiation treatment. In this surgery, the ovaries are removed from the area undergoing radiation, in order to protect them. 

Before starting treatment, it is imperative  that you consult your doctor especially if you intend to become a parent after remission. You need to have “the conversation” early on to think about ways you can preserve fertility, whether through ovarian transposition, freezing of eggs or embryos, or surgery. As with most life-threatening ailments, it's important to state that delaying therapy shouldn't come at the expense of maternal survival. And any changes to the conventional treatment must be carefully discussed with the patient and her partner/family before being considered. 

Dr Pratima Raj is associate consultant, gynaecological oncology at Manipal Hospital, Old Airport Road, Bengaluru. 

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