3 Discussion
The favorable fertility outcome in the case presented herein indicates
that FSS with adjuvant BEP chemotherapy may be a reliable treatment
alternative in patients with advanced dysgerminoma who desire to
preserve their fertility. However, large-scale studies are needed to
validate the safety and feasibility of using this approach in
advanced-stage patients.
Post-treatment pregnancy rates in patients who survived MOGCT are
influenced by a range of sociodemographic and clinical factors,
including age and desire for future motherhood [4]. Solheim et
al. [1] reported an encouraging 87.2% post-treatment pregnancy
rate in patients who survived MOGCT attempting to get pregnant.
Similarly, Chu et al. [2] reported that 85.4% of the MOGCT
patients with planned pregnancies had successful delivery. Tamauchiet al. [13] reported that 40.0% of the 105 MOGCT patients
who underwent FSS became pregnant after surgery, and 38.1% had
successfully given birth, accounting for 95.2% of the patients who
desired to become pregnant. On the other hand, there are also studies
that reported relatively lower pregnancy and childbirth rates in this
patient group [4, 14, 15].
The discrepancies between reported pregnancy rates in this patient
population may be due to the fact that all patients were taken into
account in some studies, and only patients with pregnancy plans were
taken into account when calculating the pregnancy rate in others. The
lack of fertility evaluation in all patients included in the studies and
the differences in follow-up periods and evaluated number of pregnancies
may also have contributed to the discrepancies between reported
pregnancy rates in this patient population [12]. In sum, independent
risk factors predicting pregnancy outcomes remain controversial due to
inconsistencies between relevant studies available in the literature.
Large-scale studies are needed to identify the independent risk factors
that can predict pregnancy outcomes.
The number of cisplatin-based chemotherapy cycles and cumulative doses
of chemotherapeutics reportedly impact reproductive and sexual functions
[1, 16]. Several studies found a correlation between having three or
fewer cisplatin-based chemotherapy cycles and higher fertility rates
[1, 4]. In contrast, our patient achieved spontaneous pregnancy
despite undergoing four cycles of chemotherapy. Similarly, Ghallebet al. [11] reported three full-term natural pregnancies
following FSS and six cycles of chemotherapy in MOGCT patients featuring
a seminomatous component with an advanced-stage yolk sac tumor.
FSS has been asserted as the primary treatment modality in patients with
early-stage (FIGO stages I and II) MOGCT [4, 8, 13, 15, 17].
However, considering that most cases included in these studies were at
an early stage, it can be argued that they could not accurately
represent real-world data. Husainiet et al. [14] reported
32% as the pregnancy rate in patients with pure dysgerminoma, 33.8% of
whom had FIGO stage III disease, indicating 87.5% of the patients who
have been trying to get pregnant became pregnant. A study conducted in
Iran [12] reported the delivery rate as 73% in 26 patients who have
been trying to become pregnant, approximately half of whom had FIGO
stage III disease. The fact that our patient with FIGO stage III disease
also gave a successful delivery supports the idea that many
advanced-stage MOGCT patients can achieve pregnancy after being treated
with FSS coupled with adjuvant chemotherapy.