Gestational Trophoblastic Diseases: Curing Without Compromising Fertility?
Seance of wednesday 12 november 2025 (Chirurgie de la reproduction, préservation de la fécondité)
DOI number : 10.26299/3624-t755/emem.2025.46.02
Abstract
Gestational trophoblastic diseases (GTDs) encompass a spectrum of placental disorders that include premalignant forms—hydatidiform moles—and malignant forms, known as gestational trophoblastic neoplasia (GTNs), which most often arise secondary to a molar pregnancy.
In these young women, the therapeutic objective is twofold: to achieve cure while preserving fertility.
Treatment of molar pregnancies relies on conservative uterine suction evacuation and meticulous monitoring of serum hCG levels.
Management of GTNs is based on early detection through post-molar hCG surveillance and on risk stratification according to the FIGO scoring system, which guides therapeutic choices. Specialized, centralized care coordinated by national reference centers allows for individualized strategies according to histologic type and prognostic profile. Thanks to risk-adapted chemotherapy and the centralization of care, fertility preservation is the rule, except in rare, chemoresistant cases. Most patients achieve complete remission and subsequently conceive without an increased risk of fetal abnormalities or disease recurrence.
The French National Reference Center for GTD, established in 1999 and accredited by the French National Cancer Institute (INCa), has played a decisive role in achieving these excellent outcomes. The recent introduction of immune checkpoint inhibitors (anti-PD-1, anti-PD-L1) opens promising perspectives, potentially offering effective treatment with lower gonadotoxicity.
Prof. François Golfier, MD, PhD — Lyon Sud University Hospital, Claude Bernard University Lyon 1; Founder, French Reference Center for Gestational Trophoblastic Diseases; President, International Society for the Study of Trophoblastic Diseases (ISSTD).
In these young women, the therapeutic objective is twofold: to achieve cure while preserving fertility.
Treatment of molar pregnancies relies on conservative uterine suction evacuation and meticulous monitoring of serum hCG levels.
Management of GTNs is based on early detection through post-molar hCG surveillance and on risk stratification according to the FIGO scoring system, which guides therapeutic choices. Specialized, centralized care coordinated by national reference centers allows for individualized strategies according to histologic type and prognostic profile. Thanks to risk-adapted chemotherapy and the centralization of care, fertility preservation is the rule, except in rare, chemoresistant cases. Most patients achieve complete remission and subsequently conceive without an increased risk of fetal abnormalities or disease recurrence.
The French National Reference Center for GTD, established in 1999 and accredited by the French National Cancer Institute (INCa), has played a decisive role in achieving these excellent outcomes. The recent introduction of immune checkpoint inhibitors (anti-PD-1, anti-PD-L1) opens promising perspectives, potentially offering effective treatment with lower gonadotoxicity.
Prof. François Golfier, MD, PhD — Lyon Sud University Hospital, Claude Bernard University Lyon 1; Founder, French Reference Center for Gestational Trophoblastic Diseases; President, International Society for the Study of Trophoblastic Diseases (ISSTD).