Posted by: mobilis | 2009/03/09

radical trachelectomy

I was diagnosed with stage 1B1 cervical cancer and had a radical trachelectomy in September 2008, which was successful. An abdominal cerclage was placed at the same time.

We have been advised that it will be difficult for me to conceive because of the absence of the cervix and cervical mucous. Unfortunately, our attempts at AI have also been unsuccessful because the cervical os is too tight to allow a catheter through, although it is sufficient to allow menstrual blood through.

The surgeon who performed the trachelectomy told me that it ought to be possible to dilate the os, but that doing so might lead to a trade-off with the security of the cerclage. If it isn' t dilated, then ZIFT/TET is the only option really open to us, as I' m concerned about the risk of multiples with GIFT.

At this stage I' m inclined to leave the cerclage as it is and try ZIFT/TET. However, we have not tried to conceive on our own. A post-coital test was done, which showed no sperm left alive after 2-3 hours, so we assumed that it would be best to go for fertility treatment immediately. At that stage we only really contemplated AI, and the costs of ZIFT/TET are substantially more than AI.

I' m 35 years old and neither I nor my partner have any other fertility issues. We have previously conceived without difficulty.

Is it worth trying to conceive on our own or should we go straight for ZIFT/TET? Would any of the " sperm-friendly"  preparations on the market in any way help to fulfil the functions of cervical mucous?

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Our expert says:
Expert ImageFertility expert

Dear Mobilis

My first recommendation is to continue pursuing the AI method (IUI). There are several different methods of inserting the catheter and I would suggest that a few mock attempts be made to establish the exact anatomical distortion. It is extremely unlikely that the encirclage is causing the significant stenosis (tightness) of the canal. More likely it is distortion due to scar tissue formation and this can readily be overcome with the correct type of catheter or guide. Should this not be successful after 3 attempts then perhaps a look at limited stimulation tubal embryo transfer might be the better option.

Answered by: Dr M.I. Cassim

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