Reproductive outcomes after treatment of patients with gestational trophoblastic neoplasia

Objectives : To assess reproductive outcomes of gestational trophoblastic neoplasia (GTN) patients after treatment. Methods : Patients with GTN who had treatment in our institution during January 2003 to December 2018 were identified. The patients must have had conservative treatment with intact uterus. Data collected were age at GTN diagnosis, menstrual and obstetrical history, characteristics of GTN, treatment, reproductive outcomes including menstrual and fertility function after treatment. Results : From 80 GTN patients, 74 patients had available clinical data. Total of 50 patients met inclusion criteria. Their mean age was 30.8 ± 7.7 years old; 88.0% were 40 years or younger. Thirty-nine of 50 patients (78%) were in stage I and the other 11 patients (22%) were in stage III. Most patients were in low risk group with only 2 (4%) were high risk. All except one had chemotherapy. Methotrexate was the most common first line chemotherapy, 86.0%. Only 5 of 50 (10%) had abnormal menstruation: delayed menstrual resumption, abnormal pattern, or amenorrhea. The 41 patients who desired pregnancy had younger age and lower parity than the other nine who did not want further fertility: mean age of 28.7 years old and parity of 0.5 compared to 40.4 years and 2.1, respectively (P<0.001 both). Total of 22 patients of 41 patients who desired for pregnancy (53.6%) got pregnant. The median interval time after complete treatment to pregnancy was 2.7-97.2 months (median 43.6 months). Total of 33 pregnancies were achieved resulting in 28 live births (84.8%), 4 abortions (12.1%), and one repeated molar pregnancy (3.0%). Conclusions : Almost all GTN patients (90%) could resume normal menstruation. Slightly more than half of the patients who desired for pregnancy could have at least 1 pregnancy after treatment with chemotherapy. Normal live births were achieved in 84.8% without perinatal adverse events.