FERTILITY RESULTS AFTER OVARIAN TRANSPOSITION FOR PELVIC MALIGNANCIESTREATED BY EXTERNAL IRRADIATION OR BRACHYTHERAPY

The aim of this study was to assess the fertility outcome after ovaria n transposition with uterine conservation and pelvic irradiation thera py for pelvic cancer. A total of 37 consecutive cases were reviewed, O f these, 27 patients were treated for a clear cell adenocarcinoma of t he vagina and/or the cervix (group 1), nine for an ovarian pure dysger minoma and one for a para-uterine soft tissue sarcoma (group 2), The p regnancy rate was 15% (4/27) in group 1 and 80% (8/10) in group 2 (P = 0.01). A total of 18 pregnancies was observed in 12 patients, Of thes e, 16 pregnancies were obtained spontaneously and two after in-vitro f ertilization. Of the spontaneous pregnancies, 12 (75%) were observed w ith ovaries still in the abdominal cavity (not repositioned), These re sults show that the prognosis for fertility is excellent after ovarian transposition and irradiation in patients with morphologically normal genital tracts (group 2), The prognosis is not as good for patients t reated for a clear cell adenocarcinoma of the vagina and/or the cervix who may have morphological and/or functional anomalies of the genital tract, following exposure to diethylstilboestrol and brachytherapy (g roup 1), Furthermore, these results show that repositioning of the ova ry is not essential to achieve pregnancy.