Successful pregnancies following an egg donation program in women with previously treated Hodgkin's disease.

ABSTRACT

BACKGROUND AND OBJECTIVES: In order to draw attention not only to patients affected by a neoplasia, but also to those who may have problems of sterility, we describe six women affected by Hodgkin's disease who had precocious menopause due to chemotherapy and/or radiotherapy but who were safely delivered of children. These pregnancies were achieved through oocyte donation, in vitro fertilization and intrauterine embryo transfer or oocyte intracytoplasmic insemination. DESIGN AND METHODS: During natural or iatrogenic menopause, the uterus preserves its capacity to respond to steroidal hormones and to permit implantation and development of an embryo. Our study concerns six young females with iatrogenic menopause caused by treatment of Hodgkin's disease who carried a pregnancy to term. The pregnancies were achieved by oocyte donation, in vitro fertilization and intrauterine embryo transfer or oocyte intracytoplasmic insemination. Endometrial maturation was obtained by administration of estradiol and progesterone. Steroidal therapy was administered until the 13th-14th week in relation to placental function. RESULTS: Five of the 6 females underwent Caesarean section because of a twin birth or complications during the third trimester of pregnancy (gestosis). All the delivered children are, to date, well; their median age is 4 years. INTERPRETATION AND CONCLUSIONS: This study confirms the possibility of women treated for Hodgkin's disease being able to carry a pregnancy safely to term with the help of steroidal therapy. Careful clinical and obstetric surveillance is important. Focusing attention on long-term survivors of Hodgkin's disease, we set the goal of improving the quality of life of these patients, considering their psychophysical well-being as a whole. Greater attention to the problems of safeguarding fertility in these patients would be advisable, also in the light of legislative regulation of medical care techniques in various countries.