Fertility after gestational trophoblastic disease
Fertility means the ability to get pregnant. After having gestational trophoblastic disease (GTD), some women might want to try again for a baby. It is natural to wonder when you will be able to do this and whether you are at risk of GTD happening again.
There are different types of GTD and these include:
- molar pregnancy
- invasive mole
- choriocarcinoma
Your doctor and specialist nurse will speak to you about your treatment and how it can affect your fertility.
Your periods and GTD
Due to the high levels of a hormone called human chorionic gonadotrophic hormone (hCG) in molar pregnancies, invasive mole and choriocarcinoma, your monthly periods may stop.
Surgery to treat a molar pregnancy might include dilation and suction evacuation (D and E) or dilation and curettage (D and C). After these operations, the hCG levels usually fall and once the level is lower, your periods will start again.
If you have 
your periods usually stop for the time you are having treatment. Some women who have methotrexate into their muscle might have irregular bleeding during their chemotherapy treatment.
If you have a combination of chemotherapy drugs, your periods will stop during treatment. They usually start again within 3 to 6 months of treatment ending.
The is when you stop having periods. After treatment, some women go through the menopause at a younger age than if they had not had treatment. Studies have shown that women who have a combination of chemotherapy drugs for GTD start the menopause about 3 years earlier than usual. Women over the age of 45 may find that their periods don’t come back at all after chemotherapy treatment. So they go through an early menopause at the time of treatment.
Signs of the menopause include a change in your periods and symptoms such as hot flushes. If you have any symptoms of early menopause let your GP or specialist know. It is safe to have hormone replacement therapy after treatment for GTD. Your specialist can talk to you about this.
Your fertility after GTD
You can still usually have children after most treatments for GTD. And it is still possible to become pregnant if you’ve had chemotherapy treatment.
It is important not to get pregnant for some time after you have had GTD. It is possible to get pregnant even before your periods have returned to normal. You should follow the advice about contraception from your specialist team. If you do get pregnant before your team tells you it is safe, you should let them know straight away.
You won’t be able to have children if you need to have your removed (a hysterectomy). But this type of surgery is not very common for GTD. When planning your treatment, your doctor will talk to you about a hysterectomy if they think it might be necessary.
Getting pregnant again after GTD
It is important not to get pregnant again until your doctors say it is safe for you to try. This depends on:
- your type of GTD
- the treatment you have
- your hCG levels
If your only treatment was surgery with a D and C or D and E, you can usually try to get pregnant as soon as your hCG follow up is complete. If you became pregnant earlier you would have hCG in your blood and urine tests. This would make it difficult to monitor your GTD. And know for sure that it has completely gone. The risk of GTD coming back is highest in the first few months.
If you have chemotherapy, you will need to wait a year after finishing your treatment before you try and get pregnant again.
It’s important to know that having GTD does not increase your risk of having a baby with abnormalities. Your risk of this happening is no greater than it would be if you hadn’t had GTD. Even after chemotherapy treatment, the chance of having a healthy baby is the same as for any other woman of the same age.
The risk of having another molar pregnancy is also low. Only about 1 out of 100 women (about 1%) have another molar pregnancy.
Contraception after GTD
It is safe to use after treatment for GTD. Speak to your specialist team before starting any contraception. These include:
- oral contraceptive pill
- contraceptive patch
- implants
- depot injection
- intra uterine system (IUS)
- diaphragm or cap
Help and support
This can be a worrying and difficult time for you, your family, and friends. The specialist GTD centres have support groups for people affected by any form of GTD. If there isn’t a group near you, you may be able to join one by video. This means you can still talk to others and share experiences from home. Your local centre can tell you more about this.
