Introduction: Malignant ovarian germ cell tumours (MOGCT) and gestational trophoblastic neoplasms (GTN) of uterus are diseases affecting females during their reproductive age. With the advent of combination chemotherapy there has been higher cure rates in these diseases and thus there is a shift in the focus to study the quality of life of these females in terms of their menstrual and reproductive health following their treatment. The aim of our study is to investigate menstrual and reproductive functions of the females who attained remission following treatment of MOGCT with conservative surgeries and adjuvant combination chemotherapy and in females with high risk GTN treated with combination chemotherapy with or without fertility preserving surgeries.

Methods: Between January 2000 to December 2015, a total of 227 MOGCT and approximately 71 patients with high risk GTN who underwent treatment at our institute were included in this study. The current study was retrospective analysis of menstrual health and reproductive function of these patients following their remission which were prospectively collected during their follow up visits.

Results: Among the 227 MOGCT patients, 188 underwent fertility preserving surgery which was followed by adjuvant chemotherapy with 3 to 4 cycles of BEP (Bleomycin, Etoposide, Cisplatin).  Among the 54 pre–menarchal patients, 35 (64.8%) attained menarche and the cycles were regular and normal and among 173 post menarchal patients 166(95%) resumed their cycles within 6months of their remission. Among the patients on follow–up, 16 patients desired to conceive, of which 14(87.5%) patients conceived and 7 (58%) had achieved at least one pregnancy. Five (41%) had achieved at least two pregnancy. Nine (64.5%) delivered healthy term baby and 2 patients had spontaneous abortion and 3 were lost to follow up after conception. Average time interval between completion of chemotherapy and conception was 24 months (ranging from 5 months to 60 months). Among the patients who conceived, 9 were International Federation of Gynaecology and Obstetrics (FIGO) stage I, none were stage II, and 3 were stage III. Average dosage of chemotherapy received by these patients were 210U for Bleomysin (120 to 300U), 2600mg for Etoposide (2000–3200mg) and 520mg for cisplatin (400 to 640mg).

Among the high risk GTN who attained remission and were on follow–up, 21 patients desired conception, of which 14(66.6%) patients conceived, 8(57.1%) had received EMACO as the first line chemotherapy and had remission, 6(42.8%) had to receive in addition 2^nd line chemotherapy EMAEP to attain remission. Three patients underwent conservative resection of the uterine tumor in addition to chemotherapy to attain remission. Four patients had more than one subsequent pregnancy. Of the patients who conceived average cycles of EMACO was 6.  During the follow up period 4 conceived within 1yr(in spite of contraception being advised), 10 conceived within 2–5yrs of remission. During chemotherapy, 97% of patients developed amenorrhea but 94% of these women resumed normal menstrual function within 6 months of completion of chemotherapy. Six (2.6%) had premature ovarian failure.

Conclusion: Fertility sparing treatments are safe in patients with MOGCT and in high risk GTN. Among the patients who attempted conception, most of them conceived and had healthy children. Combination chemotherapy has dramatically improved the prognosis in both these group of patients. Treating surgeons should have a comprehensive approach in counselling the patients regarding fertility sparing procedures and positively assure them regarding future reproductive function.