The complexity and challenges of fertility preservation in women with cervix cancer - A prospective cohort study reporting on reproductive outcome and overall survival

Sep 21, 2026

Objective assesses the feasibility of fertility preservation in women referred for cervix cancer, with emphasis on long-term reproductive outcome and overall survival. Prospective cohort data were collected for patients counseled within 1999–2021 in a Swedish fertility preservation program. Baseline disease and treatment factors were analyzed, and reproductive outcomes and survival were retrieved from clinical and population-based registries through October 19, 2023. Results summarize referral patterns, FP uptake, follow-up outcomes, and mortality differences.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Introduction

Material and Methods

Results

Conclusions

Abbreviations

1 | Introduction

DOI: 10. 1111/aogs.15007 OR I G I NAL R E S E AR C H The complexity and challenges of fertility preservation in women with cervix cancer—A prospective cohort study reporting on reproductive outcome and overall survival Anna Marklund1,2 | Yanyu Jiang2 | Hanna Röjlar1 | Fotios Sergouniotis1,2 | Hanna Nilsson1 | Frida E. Lundberg2,3 | Kenny A. Rodriguez-Wallberg1,2 1Department of Reproductive Medicine, Division of Gynecology and Reproduction, Karolinska University Hospital, Stockholm, Sweden 2Department of Oncology and Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institutet, Stockholm, Sweden 3 Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Correspondence Kenny A. Rodriguez-Wallberg, Department of Oncology and Pathology, Laboratory of Translational Fertility Preservation, BioClinicum J 5:30, Visionsgatan 4, New Karolinska Hospital, Karolinska Institutet, 171 64 Solna, Sweden. Email: [kenny. rodriguez-wallberg@ki.se](kenny. rodriguez-wallberg@ki.se) Funding information Vetenskapsrådet, Grant/Award Number: 2020-02230 and 2021-06116; Radiumhemmets Forskningsfonder, Grant/Award Number: Dnr: 201313; Barncancerfonden, Grant/Award Number: KP2022-0081; Stockholm läns landsting, Grant/Award Number: grant FoUI-953912; Karolinska Institutet Research grants; Cancerfonden, Grant/ Award Number: 190249Pj and 20 0170F Abstract Introduction: Our objective was to assess the feasibility of fertility preservation (FP) in women referred for cervix cancer, the long-term reproductive outcome, and overall survival. Material and Methods: Prospective cohort study of patients referred for FP counseling between 1999 and 2021 to the FP program of Karolinska University Hospital, Stockholm, Sweden. Baseline data included age, parity, disease stage, treatment characteristics, and FP methods applied. Data on reproductive outcomes and overall survival (by October 19, 2023) were retrieved from clinical registries and a populationbased register. Trial registration number: ClinicalTrials.gov NTC04602962 . Results: In total, 91 women were referred, 67% with stage I cancers and 25%, 7%, and 1% with stages II, III, and IV, respectively. Cancers were diagnosed during pregnancy or postpartum in six cases. Cancer treatments included fertility-sparing surgery in 14%, hysterectomy in 30%, and radiochemotherapy in 79% of cases. The treatment modality did not rule out the possibility to undergo FP, and following counseling, 68 patients elected to undergo FP by cryopreservation of embryos or oocytes (N = 11), ovarian tissue (N = 54), or both (N = 3) . After a mean follow-up of 8.1 years, 25 women (37%) returned to the center, five women achieved conception either spontaneously or through assisted reproduction, and 11 women became mothers through adoption or surrogacy. In the group of women receiving radical surgery or chemo/radiotherapy, no live births using cryopreserved specimens have yet been achieved. During followup, 7 women (10%) in the FP group and 5 women (24%) in the group without FP had died of their disease. Cancer recurrence was documented in 19 patients. Conclusions: Our findings underscore the complexity and challenges associated with FP in the context of cervix cancer. Results of this study demonstrate that many women diagnosed with cervix cancer at reproductive age desire to achieve Abbreviations: COS, controlled ovarian stimulation; FP, fertility preservation; FSS, fertility-sparing surgery. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. © 2024 The Author(s) . Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG) . parenthood. While

FAQs

What was the objective of the prospective cohort study?

To assess the feasibility of fertility preservation in women referred for cervix cancer, and to evaluate long-term reproductive outcome and overall survival.

How were reproductive outcomes and overall survival obtained?

Data were retrieved from clinical registries and a population-based register, with follow-up through October 19, 2023.

What fertility preservation methods did patients elect after counseling?

After counseling, patients underwent cryopreservation of embryos or oocytes, ovarian tissue, or both.

Sep 21, 2026

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