An innovative uterine transposition procedure protects reproductive organs from damage caused by radiation therapy.
A surgical technique designed to preserve fertility in women undergoing pelvic radiation therapy has been performed for the first time in Canada at the McGill University Health Centre (MUHC). This procedure, known as uterine transposition - developed and performed by Dr. Reitan Ribeiro - offers immense hope to women with colorectal and other pelvic cancers who wish to retain the ability to conceive and carry a pregnancy to term after remission, while reducing the risk of early menopause.
"With the rising incidence of cancer among young women and the trend toward later motherhood, it is becoming essential to consider not only cancer treatment but also patients' quality of life and future plans," explains Dr. Reitan Ribeiro, a gynecologic oncologist at the MUHC and Senior Investigator at the Women's Health Research Unit of the Research Institute of the McGill University Health Centre (The Institute). "Uterine transposition allows patients with pelvic tumours that do not involve the reproductive organs to undergo radiation therapy without having to give up their desire to start or expand a family in the future."
Uterine transposition involves moving the uterus, ovaries and the fallopian tubes upward into the upper abdomen during an initial surgical procedure to protect them from the radiation field during radiation therapy. Once treatment is complete, the reproductive organs are repositioned to their original pelvic location during a second procedure. Performed using minimally invasive techniques, this procedure promotes rapid recovery and does not delay the start of cancer treatment.
Britany Fecteau, a 28-year-old woman treated at the MUHC for Hodgkin's lymphoma in the groin, is the first patient in Canada to undergo this procedure. The initial procedure took place on February 26, 2026, and the second on April 29, 2026, one month after the completion of radiation therapy.
"Receiving a cancer diagnosis at my age was a tremendous shock. Learning that the treatments could also cause me to lose my fertility and put me into early menopause was just as shocking. This surgery allowed me to preserve my ovaries and uterus before radiation therapy, and that means the world to me. As a young mother, knowing that this option exists gave me hope and helped me get through the treatments with a little more peace of mind," says Britany. "I hope my story can help raise awareness of this option for other women facing a similar situation."
Since Dr. Ribeiro developed the uterine transposition technique in 2017 while practising at Erasto Gaertner Hospital in Brazil, more than 45 procedures have been performed worldwide, and six natural pregnancies have been carried to term following the procedure-without the use of assisted reproductive technologies.
"Offering fertility preservation options to young cancer patients is invaluable to them and their loved ones, and is an integral part of our vision for innovative, patient-centred oncological and surgical care," says Dr. Lucy Gilbert, an internationally recognized researcher in gynecological cancers, Director of Gynecologic Oncology Cancer Services at the MUHC and Chair of the Gerald Bronfman Department of Oncology at McGill University. "We are proud to recruit the best experts, such as Dr. Ribeiro, to advance women's health."
Irreversible effects of radiation therapy on fertility and hormonal health
Radiation therapy plays a key role in the treatment of many cancers, including colorectal and gynecological cancers. However, even at low doses, radiation inevitably causes irreversible damage when it reaches the reproductive organs. Radiation impairs ovarian reserve and causes uterine atrophy, leading to the loss of reproductive capacity.
Radiation also affects the endocrine function of the ovaries by interrupting estrogen production, which can trigger early menopause.
"Beyond the loss of fertility, damage to the ovaries has significant repercussions on women's physical and psychological health. Early menopause increases the risk of cardiovascular disease and osteoporosis, in addition to causing symptoms such as hot flashes, fatigue and mood swings," notes Dr. Ribeiro, who is also Associate Professor in both the Gerald Bronfman Department of Oncology and the Department of Obstetrics and Gynecology at McGill University. "By preserving ovarian as well as uterine function, this procedure eliminates the risk of premature menopause."
Until now, the main option for preserving fertility before cancer treatment has involved artificial stimulation of the ovaries followed by the retrieval and freezing of eggs. This approach delays the start of cancer treatment and is dependent on assisted reproductive technology, which is expensive for patients, and is limited by the number of eggs successfully retrieved. Most importantly, when the uterus has been damaged by radiation therapy, it eliminates a woman's ability to carry a pregnancy.
In contrast, uterine transposition is part of a more comprehensive approach to oncology, in which care is no longer limited to treating the disease itself but also takes into account the long-term effects of treatment.
"The MUHC is proud to have achieved this Canadian first in oncological and gynecological surgery. With this breakthrough, our institution aims to become a leading centre for fertility preservation among patients undergoing cancer treatment," says Dr. Gilbert.
Dr. Ribeiro received the award for Best Surgical Video from the Society of Gynecologic Oncology in 2017 in Washington, DC, and was also awarded the 2025 Outstanding Achievement in Gynecologic Oncology Surgery Award by the International Gynecologic Cancer Society (IGCS), in recognition of his global impact in the fields of surgical innovation, clinical research and training in gynecologic oncology.
The MUHC warmly thanks the Carole Epstein Foundation, the MUHC Foundation and the Rossy Cancer Network for their invaluable support of the Uterine Transposition Program. The MUHC also wishes to acknowledge the contributions of Dr. Jean Deschênes, former Director of Professional Services at the MUHC, as well as Dr. Marie-Josée Bédard, Dr. Julie Lajeunesse and Laurence Duermael of the Collège des médecins du Québec (CMQ).
