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Pregnancy after an abdominal radical trachelectomy

Diana76
0 Recommendations

Hi, about 2.5 years ago I was diagnosed with cervical adenocarcinoma stage 1b1 and went through an abdominal radical trachelectomy. Now we are trying to conceive (half a year we tried naturally and now we started IUI). A few days a go I read good news of a 39 old woman who conceived naturally after a vaginal radical trachelectony and I was wondering if the chances are the same like after an abdominal radical trachelectomy.

Has anyone here succeeded to conceive after an abdominal radical trachelectomy? If yes, did you succeed naturally, or after IUI/IVF?
How was the pregnancy? Was it a full term preganacy? Did you have the cervix stitched in order to avoid an abortion?

I'd be glad to get some advice.

Thanks

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49 replies

LUV2BFLYIN

I HAD MY SURGERY IN JUNE OF 2007 AFTER FINDING OUT THAT I HAD THE EXACT SAME THING YOU DID. MY DOCTOR MADE US WAIT TWO YEARS SO WE HAVE BEEN TRYING JUST SINCE JUNE. WHAT MADE YOU DECIDE TO TRY IUI? MY DOCTOR SENT ME SOME STUDY THAT WAS DONE AND THE STUDY WAS VERY POSITIVE. WHAT HAS THE SPECIALIST SAID IF YOU GET PREGNANT? MINE HAD NEVER SEEN ANYONE LIKE ME BEFORE. I BELIEVE I HAVE LESS THAN AN INCH OF CERVIX LEFT. SHE TOLD ME THAT I WOULD PROBABLY BE ON BEDREST AND WOULD HAVE A HIGHER RISK OF 2ND TRIMESTER MISCARRIAGE....I JUST HOPE I CAN GET PREGNANT WITHOUT HAVING TO DO FERTILITY CAUSE SHE ALSO TOLD ME I WOULD NOT BE ABLE TO CARRY MORE THAN ONE CHILD??

karchibald

I am also curious how this goes as I had an abdominal trachelectomy 2 years ago. I've finally met someone and would like to get pregnant but I'm worried about all the risks and have so many questions. Other than my oncologist, my OB/GYN has never had a patient who has had this surgery so I have no idea if I work with her or find an OB that specializes in high risk pregnancies. My oncologist did say I would be high risk, most likely on bedrest most of the pregnancy and not carry to full term...not to mention the need for a c-section. He did say it could be a one shot deal but they really don't know since not many people have gone this route. It makes me so nervous to know the road ahead but I'm hoping the day I'm holding my child this will all be worth it in the end!

Diana76

Hi girls, I had my surgery in January of 2007. I also had to wait 2 years before trying to conceive and now, half a year after trying to conceive naturally, without success, I had my first and hopefully my last IUI (I'll know only in about a week). My doctor wanted us to get pregnant ASAP, since I'm already 33.5 year old and he advised us to consult a fertility specialist who advised to try IUI. For my doctor I'm not the first patient who had this operation, but he operated only a couple of patients before me and all and all there are only a few women in my country (Israel) who had that operation, so they don't have a lot of experience. I was told that the chances of getting pregnant are fair and that there is a risk of abortions / preterm delivery esp. in the 2nd trimester, therefore the pregnancy should be monitored closely. My cervix is 8-9 mm long and I don't have a cerclage. Do you have one?
Regarding the fertility treatments, it's correct that it'll be very dangerous to carry more than 1 child, therefore I don't take hormones and had the IUI on a natural basis, without hormones ( my hormonal profile is normal and also my husbend's sperm is normal, so it's possible without any hormones).
The IUI is a simple precedure, however, since my fertility specialist is not so familiar with this kind of surgery he couldn't find the opening of the cervix and it was a bit painful. Finally, he decided to call a gyneco-oncologist who is familiar with this surgery and he found it almost immediately, so in case you do IUI be prepared that there might be some difficulties in finding the opening of the cervix, but if you have a normal menstruation, it means that the opening is not blocked and finally they will find it.
karchibald, I understand that you're nervous, but don't forget that we are lucky at least to have the chance to try to conceive, not like many women who had to go through hysterectomy. Try to think positive and be strong, don't let the worries and fears weaken you.

I'll be glad to hear from you girs soon

LUV2BFLYIN

diana,
yes i guess i have a cerclage??!! the weird thing about that is that my oncologist put in his notes after the surgery that he had put in a abdominal cerclage, but then when he talked to the specialist he told her that he didnt think what he put in would hold a pregnancy...she was confused as was i. the specialist said that they could open me up now and put another abdominal cerlage on top of the one he put in or that we could wait until i got pregnant to see how it was holding up and then if they had to they would open me up and put one in. there is not enough cervix for a cervical cerclage so i guess we will wait and see what happens. are your menstrual cycles regular? mine have not been but at least i am having one. i live in atlanta and as far as i know my doctor is the only one here that performs radical trach. i was his first patient and he has since performed 2 more. i am anxious to see what happens....

mobilis

Hi Diana

I had a radical abdominal trachelectomy in September last year. I wasn't told to wait 2 years - I was given the go ahead at my first checkup in December to begin trying to get pregnant. Possibly this is because I was 35 (turning 36 next month).

The advice I got was to try IUI immediately without trying on my own (with my partner I mean!) first, possibly also in view of my age. We've been trying since January. The FS also had difficulty finding the cervical opening, and in my case it did also close up and need to be dilated. We eventually had our first IUI at the beginning of May and our fourth last week. We're also not using any meds, for the same reason, and if we aren't successful after this attempt the FS will do a hysteroscopy and laparoscopy, as he's concerned there may be scarring or other damage to the uterus from the trachelectomy. If all looks fine we'll try another 2 IUIs (total of 6) and then IVF - single embryo transfer.

I have an abdominal cerclage, which all my doctors are happy with, but they have warned that it might not be enough. Bedrest has been mentioned! The surgeon who originally performed the trachelectomy said that we have about a 60% chance of a live birth. The 40% "wastage" (his word!) includes the usual 15% chance of miscarrying in the first trimester, even in normal pregnancies. The balance is mostly second trimester miscarriage .

I've already chosen and consulted with a high risk obstetrician who will monitor my pregnancy if we manage to achieve one.

There are a few women on this board who have had successful pregnancies after trachelectomies, and a couple who are currently pregnant. If you search on "pregnancy after trachelectomy" you'll find a couple of threads.

Best of luck with your IUI, I'm testing on Tuesday, so we'll probably get our results around the same time.

Diana76

Hi LUV2BFLYIN & mobilis, My surgent decided not to put a cerclage after consulting the dr. who invented this kind of surgery. He told me that the cerclage wasn't proven to be really benefitial in preventing miscarrage or a preterm delivery. My current oncologist uses to put a cerclage, but he told me that a 8-9 mm of cervix may be enough to hold a pregnancy and that we should give it a try without a cerclage, but it can be that he'll decide to put a cerclage during the pregnancy (hopefully it won't be needed). Once you have the cerclage, how is it possible for the sperm to get inside the uterus, doesn't it block the opening of the cervix?
My menstrual cycles are regular, every 28-32 days, however the bleeding is less than before the surgery, but in the ultrasound they did before my IUI they saw that thickness of the uterus' mucous was approx 8 mm, which is totally OK. Have you had an ultrasound done? In my ultrasound everything seemed to be OK: normal size of uterus, normal ovaries, normal mucous. I asked if a uterus radiography is required in order to see if there is a damage to the fallopian tubes, but my oncologist said that there is only 10% risk that they were damaged/blocked and that we should first try the IUI and if it won't be succeful, then we'll do it maybe. I hope that the IUI will be susccessful, but if not we'll have to have IVF. Do you know how the IVF should be done? After all, they don't really want to give hormones, in order to prevent multipale embrios. Can they do IVF without hormones?
I was looking for stories of women who got pregnant after an abdominal radical trachelectomy, but only found stories of pregnancies after a vaginal radical trachelectomy. Do you know if there is a difference between those two methods in terms of pregnancy rates? Could you send me the links to the stories of pregnancies after an abdominal radical trachelectomy?
I wish you girls a lot of luck. Hopefully, we'll soon fulfil our wish.
Hope to hear from you soon...

mobilis

I don't have any cervix left, which is why I have the cerclage. I thought it was standard if the cervix was shorter than 1cm. The cerclage doesn't close off the uterus completely - it is an encircling suture, like a drawstring.

I also have less bleeding than before, but the lining of the uterus is fine on the ultrasound. Cycles around 25 days, but they might be slightly shortened by the hCG shot to trigger ovulation. Why would there be damage to the tubes after trachelectomy?

With IVF you will have hormones to stimulate follicle production, so that multiple eggs are retrieved. They are then "sucked" out of the ovaries with a thin tube and fertilised in vitro. Not all the eggs will necessarily fertilise. The resulting embryos are grown for either 3 or 5 days, depending on the protocol, and then a predetermined number are returned to the uterus. Some people transfer 2 or 3, to increase the chance that one will implant, but there is obviously a risk of multiples by doing this. I wouldn't have more than one transferred back. The remainder (not all survive for 3-5 days) can be frozen if they are high enough quality, so if the IVF is unsuccessful, or you want another child later, they can be thawed for an FET (frozen embryo transfer) without necessarily having to go through the hormone treatment and egg retrieval again.

Diana76

Apparently there are surgents who don't put the cerclage. My surgent actually consulted dr. Ungar, who was the first to perform this kind of surgery and he told him that the cerclage hasn't proven to be benefitial. My current oncologist uses to put a cerclage, therefore he made the ultrasound, but once he found out that my cervix is not totally gone and that I still have 8-9mm of cervix left, he said that he was less worried and that we should give it a try without a cerclage and monitor it closely during the pregnancy.
I haven't yet found stories of women who conceived after an abdominal radical trachelectomy on this board. I could only find stories of pregnancies after a vaginal radical trachelectomy. Do you know if there is a difference between those two methods in terms of pregnancy rates? Could you send me the links to the stories of pregnancies after an abdominal radical trachelectomy?

Thanks

Diana76

Mobils, I forgot to answer your question regarding the chance of damage to the tubes. Well, I was told that after every kind of abdominal sergery there is a small chance of damage to the tubes or the tubes might be blocked. My oncologist said that the chances are not high, only 10%. Anyway, in a uterus radiography they should be able to see if the tubes are blocked or damaged.

LUV2BFLYIN

I found the article that my doctor sent me but its for pregnancies after a vaginatl trachelectomy. I will be happy to send it to both of you.

Diana76

Can you pls. send me a link to this article?
Have you asked your doctor if there is a difference between the outcomes after the vaginal method and the abdominal
one.
It seems that there is not enough information regarding the outcomes after an abdominal radical trachelectomy, right?!

LUV2BFLYIN

The frustrating part is that I cant ever get a good answer from my oncologist when I ask him questions. I am almost certain that I was only his 2nd patient to get a radical trachelectomy. He has since done 2. I think because of this he cant truly answer my questions regarding pregnancy. There is little info about what it is like with pregnancy after this surgery and that is frustrating. My doctor never once mentioned anything about the lack of cervical mucous that I would probably have with no cervix. He never mentioned doing fertility either. I guess that since he doesnt deal with the pregnancy part of this that he may not think to tell me these things.

Diana76

I also have the feeling that there is not enough study regarding the outcomes of this surgery and, as we all know, everything is based on studies and statistics.
About the vaginal approach there is more info, may be because they started with the vaginal approach before the abdominal one.
My doctor hasn't informed me about the lack of cervical mocus either, but he mentioned that if I don't succeed to conceive naturally, I'll need to do vertility. He said that there are chances to conceive naturally, but I don't know the statistics.
Anyway, in my next visit to my gyneco-oncologist, I'll try to get some more info.
I'll keep you posted.

BAR32

Diana76, I have only been able to find one article about the difference in pregnancy rates after abdominal v. other forms of trachelectomy:
http://www.uams.edu/update/absolutenm/templates/news2003v2.asp?articleid=78 16&zoneid=18

Mine was performed abdominally as well, as all 3 oncologists that I saw felt that this was the best approach for me, since I was 1b and they wanted to make sure that they could really see what they were doing. I am worried about my chances of getting pregnant too. We have just recently started TTC.

Diana76

Hi Bar 32, the article is not really encouraging. However, we have to think positive.
What is TTC?
Have you had hysterography, in order to check the situation of the uterus and the uterine tubes?

BAR32

trying to conceive. I have not had any of those tests yet. have you?

mobilis

After your tip about the tubes, I had a laparoscopy to check out the tubes and uterus, and it turns out my tubes were damaged, probably from the lymph node removal. One has been repaired, the other is a mess. I went for a scan on Monday, and I'm ovulating this month on the damaged side. Apparently it is possible for an egg to be picked up by the tube on the opposite side - by chemical signals - but it's fairly rare. So I've decided to throw some money away on IVF with a single egg aspiration this month. Egg retrieval is tomorrow morning. Last night I had to inject myself with the hCG trigger shot - straight into the little fat roll under my navel!! Fortunately I have a big numb patch left after my surgery, I think I could stab an ice pick in there and not notice.

Diana76

Bar32, I had only hormonal tests and Ultarasound and everything seems to be OK. However, I haven't done hysterography/laparoscopy yet. I think that will be the next test, in order to check if there is a damage to the tubes.

Mobilis, I'm glad that my tip helped you. At least now you know why the IUI wasn't successful.
How was the laparoscopy done? Was it vaginally?
I heard that the tube the use is thick. Was it painful?
I wish you the best of luck on your first and hopefully last IVF.
Pls. write me how it went.

Hope to hear from you soon...

mobilis

Diana, I'm sorry I didn't see this before.

Laparoscopy is keyhole surgery, so small incisions are made in the abdomen (you may have some from the lymphedectomy - they look the same). It's done under general anaesthetic, and generally speaking you can be discharged the same day.

My fertility specialist is not able to do a hysteroscopy on me, because the cervical opening is so small and tight. The specialist who dilated it was able to dilate it as far as 1cm, but the fertility specialist is too tentative, I think probably because he hasn't seen anything like it before. He even tried under general anaesthetic, but that made it worse - without any muscle tone he couldn't even FIND the opening, let alone insert an instrument. Eventually he did an HSG by squirting the dye into the uterus through the abdominal incision during the laparoscopy, instead of introducing it via the cervical opening.

The catheter for IUI doesn't go in that easily, it's too soft. My FS uses a rigid one, typically used for embryo transfer rather than IUI. It isn't painful, it's usually a quick and simple procedure.

My IVF was cancelled in the end, because my egg fertilised but the embryo stopped growing. This cycle I'm ovulating on the left side, which is the working tube, so I had another IUI on Monday and Tuesday. Next week I'm starting meds for a long-course IVF, in case the IUI was unsuccessful.

Diana76

Hi Mobilis, I'm glad to hear from you.

I'm sorry to hear that the IVF was cancelled. Hopefully, the next IUI will be successful for you.

I had 3 IUI cycles that were not successful. Next week I have a meeting with my fertility specialist and I'll ask him regarding hysteroscopy/laproscopy. In the 1st IUI they also had difficulties finding my cervical opening, but finally they found it and from then on it was much easier and they didn't need any special tube, so I hope they will be able to do hysteroscopy, but it's good to know that there is more than 1 method.
By the way, I didn't have lymphedectomy, my lymgh nodes were taken out during the surgery itself (through the cut in the abdomen) and after they saw they were clean they continued as planned.

Why did they choose the long-course IVF? Is it better than the short-course?

Hope to hear from you soon.

Good luck!!!

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