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.