Preservation of Fertility in a Patient with a Mixed Germ Tumor and Subsequent Successful Pregnancies. A Case Report

Abstract

Objective: The objective of the study was to present the case of a patient with a diagnosis of a mixed germ cell tumor clinical stage (CS) IIC, who underwent conservative cytoreductive surgery and chemotherapy before initiation of a gonadotropin-releasing hormone agonist (GnRH-a) for fertility preservation, subsequently achieving spontaneous pregnancies. Material and methods: A 19-year-old patient underwent an examination for abdominal distention. Through clinical and imaging studies, an abdominal-pelvic mass of 15 cm × 14 cm × 10 cm was diagnosed with a location in the right ovary. After optimal cytoreductive surgery, the report confirmed a conservative germinal mixed tumor histopathology (80% endodermic sinuses and 20% embryonal carcinoma), CS IIC, so 4 cycles of chemotherapy were indicated. Before the start of and throughout the cytotoxic treatment, GnRH-a was administered. Results: At the end of the oncological treatment, a follicle stimulating hormone of 20 mUI/mL was reported, spontaneous resumption of menstrual cycles was presented 2 months after having concluded chemotherapy and suspended the use of GnRH-a. 12 months later, a spontaneous pregnancy was normally achieved, which ended with a live newborn at 38.4 weeks of gestation, and 4 years later, a second spontaneous pregnancy, which also culminated in obtaining a healthy newborn. Conclusions: Fertility preservation should be considered a fundamental aspect of the quality of life of cancer survivors. Provided that there are no contraindications, the use of GnRH-a should be considered before the start of chemotherapy, remembering that this treatment could offer benefits beyond the preservation of fertility (bone, sexual, and cardiovascular health), providing comprehensive management.