Fertility preservation in a ptient with breast and uterine cervix cancer: when the lightening stikes more than twice!

To describe cancers and myltuple gertility options in one single patient. Case report. A 31 years single parient was diagnised as suffering from breast cancer. Prior to chemotherapy she underwent emergency IVF and 8 oocytes were retreived and 4 embryos were frozen. Five years after the end of chemotherapy she returned seeking for embryo transfer of the frozen embryos. Prior to the procedure she underwent routine cervical smear which disclosed uterine cervix carcinoma. Following evaluation she underwent trachelectomy for preserving her fertility. Two years after the trachelecyomy the patient returned for embryo transfer. Estradiol valerate was given for preparing the uterine cavity, and two frozen tgawed embryos were transferred. The two embryos were ipmlanted and in this stage the patient refused early embryo reduction. The nuchal translucency and the ultrasound screening tests were normal. At this stage trial to perform abdomunal cervical cerclage failed because of technical reasons. At week 18 the patient agreed to perform fetal reduction from twins to singletone. Following the procedure she suffered from bleeding and at 25 weeks og gestation she delivered a baby 500gm.The baby was treated in the intensive care unit and 4 month later was discharged. This case presents hoe fertility preservation options might be applied in a single - single patient. The case raises the dillema of how many embryos to transfer? the need for performing circlage during trachelectomy? The need for fetal reduction early in the pregnancy and finaly deminstrates that the lightening may stike more than twice.