Abstract
Research question
Do IVF treatments after conservative management of endometrial atypical hyperplasia
or grade 1 endometrial adenocarcinoma (AH/EC) increase the risk of disease recurrence?
Design
This is a prospective cohort study from a national registry from January 2008 to July
2019. Sixty patients had an AH/EC and received progestin treatment using chlormadinone
acetate for at least 3 months. After remission, 31 patients underwent IVF and 29 did
not.
The primary outcome was the recurrence rate at 24 months according to the use of IVF.
The secondary outcome was the identification of risk factors for recurrence.
Results
The probability of 2-year recurrence was 37.7% (SD 10.41%) in the IVF group and 55.7%
(SD 14.02%) in the no IVF group (P = 0.13). Obesity, nulliparity, polycystic ovary syndrome, age and tumoural characteristics
were not associated with recurrence. Pregnancy was a protective factor for recurrence,
with 2-year recurrence probabilities of 20.5% and 62.0% in the pregnancy and no pregnancy
groups, respectively (P = 0.002, 95% CI 0.06–0.61). In contrast, the number of cycles, maximum serum oestradiol
concentration during ovarian stimulation, ovarian stimulation protocol, total dose
of gonadotrophin administered and thickness of the endometrium showed no significant
differences in terms of the risk of recurrence in the IVF subgroup.
Conclusion
IVF treatment after fertility-sparing management of AH/EC does not increase the risk
of recurrence. Therefore, it is an acceptable strategy to decrease the time to pregnancy.
Overall, the recurrence rate is high enough to justify close monitoring once remission
occurs.
Key words
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REFERENCES
- Risk of endometrial, ovarian and breast cancer in women with polycystic ovary syndrome: a systematic review and meta-analysis.Hum. Reprod. Update. 2014; 20: 748-758https://doi.org/10.1093/humupd/dmu012
- Oncologic and reproductive outcomes after fertility-sparing management with oral progestin for women with complex endometrial hyperplasia and endometrial cancer.Int. J. Gynaecol. Obstet. 2016; 132: 34-38https://doi.org/10.1016/j.ijgo.2015.06.046
- Outcome of in vitro fertilization treatment in infertile women conservatively treated for endometrial adenocarcinoma.Fertility and Sterility. 2007; 88: 1562-1567https://doi.org/10.1016/j.fertnstert.2007.01.058
- The outcome of infertility treatment in patients undergoing assisted reproductive technology after conservative therapy for endometrial cancer.J. Assist. Reprod. Genet. 2014; 31: 1189-1194https://doi.org/10.1007/s10815-014-0297-x
- Regression, relapse, and live birth rates with fertility-sparing therapy for endometrial cancer and atypical complex endometrial hyperplasia: a systematic review and metaanalysis.American Journal of Obstetrics & Gynecology. 2012; 207 (266.e1-266.e12)https://doi.org/10.1016/j.ajog.2012.08.011
- Impact of obesity on the results of fertility-sparing management for atypical hyperplasia and grade 1 endometrial cancer.Gynecol. Oncol. 2014; 133: 33-37https://doi.org/10.1016/j.ygyno.2013.11.007
- Conservative treatment with progestin and pregnancy outcomes in endometrial cancer.Int. J. Gynecol. Cancer. 2009; 19: 1068-1073https://doi.org/10.1111/IGC.0b013e3181aae1fb
- The influence of infertility treatment on the prognosis of endometrial cancer and atypical complex endometrial hyperplasia.Int. J. Gynecol. Cancer. 2013; 23: 288-293https://doi.org/10.1097/IGC.0b013e31827c18a1
- Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia.Reprod. Biol. Endocrinol. 2016; 14: 2https://doi.org/10.1186/s12958-015-0136-7
- Outcomes of in vitro fertilization cycles following fertility-sparing treatment in stage IA endometrial cancer.Archives of Gynecology and Obstetrics. 2019; 300: 975-980https://doi.org/10.1007/s00404-019-05237-2
- Prognostic factors of oncologic and reproductive outcomes in fertility-sparing management of endometrial atypical hyperplasia and adenocarcinoma: systematic review and meta-analysis.Fertility and Sterility. 2014; 101: 785-794https://doi.org/10.1016/j.fertnstert.2013.11.028
- Endometrial Cancer: Obesity, Genetics, and Targeted Agents.Obstetrics and Gynecology Clinics of North America. 2019; 46: 89-105https://doi.org/10.1016/j.ogc.2018.09.006
- Predictive factors for pregnancy after intrauterine insemination (IUI): An analysis of 1038 cycles and a review of the literature.Fertility and Sterility. 2010; 93: 79-88https://doi.org/10.1016/j.fertnstert.2008.09.058
- Addressing the Role of Obesity in Endometrial Cancer Risk, Prevention, and Treatment.J. Clin. Oncol. 2016; 34: 4225-4230https://doi.org/10.1200/JCO.2016.69.4638
- Pregnancy Outcomes After Fertility-Sparing Management in Young Women With Early Endometrial Cancer.Obstetrics & Gynecology. 2013; 121: 136-142https://doi.org/10.1097/AOG.0b013e31827a0643
- Long-term oncologic outcomes after fertility-sparing management using oral progestin for young women with endometrial cancer.Eur. J. Cancer. 2013; 49: 868-874https://doi.org/10.1016/j.ejca.2012.09.017
- Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).Hum. Reprod. 2004; 19 (Jan): 41-47https://doi.org/10.1093/humrep/deh098
- Decremental follicle-stimulating hormone and dominant follicle development during the normal menstrual cycle.Fertility and Sterility. 1995; 64: 37-43https://doi.org/10.1016/S0015-0282(16)57652-3
Biography
Martin Koskas, MD, PhD is currently professor in the Department of Gynaecological Surgery at APHP, Paris University, France. His clinical practice is focused on oncology, endometriosis and fertility. He founded and now chairs the French Registry for fertility preservation in endometrial cancer and atypical hyperplasia.
Article info
Publication history
Published online: June 16, 2021
Accepted:
June 10,
2021
Received in revised form:
June 7,
2021
Received:
March 10,
2021
Declaration: The authors report no financial or commercial conflicts of interest.Identification
Copyright
© 2021 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
