Reproductive outcomes following chemotherapy for gestational trophoblastic neoplasia: experience from a tertiary care center
Gestational trophoblastic neoplasia (GTN) affects reproductive-age women and is highly chemosensitive, with excellent survival outcomes. However, concerns remain regarding the impact of chemotherapy-particularly multiagent regimens-on reproductive and menstrual health. This retrospective, observational study included 78 women treated for GTN between 2011 and 2022. Data on demographics, disease characteristics, treatment history, menstrual changes, fertility outcomes, and pregnancy course were collected from medical records and patient interviews. Comparative analysis was performed between women who received single-agent (Group I) and multiagent chemotherapy (Group II). Logistic regression was used to identify independent predictors of live birth. The median age was 28 years (range: 17-71, IQR: 24-34). Of the 78 women, 30 (38.5 %) received single-agent and 48 (61.5 %) received multiagent chemotherapy. Menstrual abnormalities occurred in 14.1 % overall (13.3 % in Group I vs. 14.6 % in Group II; p = 0.99). Post-treatment, 35 women (44.8 %) conceived, and 30 (38.5 %) achieved at least one live birth. Cesarean delivery occurred in 46 % of live births. Among women desiring pregnancy, 20.5 % reported infertility. On logistic regression, age (OR 0.77; p = 0.009) and receipt of ≤7 cycles of combination chemotherapy (EMACO) (OR 6.03; p = 0.043) were significantly associated with live birth. Chemotherapy type was not an independent predictor. Most GTN survivors retain reproductive potential, regardless of chemotherapy type. Younger age and lower chemotherapy burden were associated with higher chances of live birth. These findings support fertility preservation counseling and tailored follow-up, particularly for high-risk patients undergoing multiagent chemotherapy.