Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia

Abstract

BackgroundPatients hoping to preserve their fertility receive conservative treatment with high-dose medroxyprogesterone acetate (MPA) for well-differentiated endometrioid adenocarcinoma (EC) or atypical endometrial hyperplasia (AEH) . Such treatment generally involves frequent intrauterine operations, including dilation and curettage (D&C) and endometrial biopsy (EMB), which could result in endometritis, endometrial thinning, or intrauterine adhesion. In turn, any of these outcomes could adversely affect implantation and pregnancy development. The current study thus aimed to identify factors that might affect pregnancy following conservative treatment by MPA.MethodsWe compared a pregnancy group (45 patients) with a non-pregnancy group (53 patients) of MPA-treated patients to evaluate the factors affecting clinical pregnancy establishment. We undertook a multivariate logistic regression analysis based on factors shown by univariate analysis to be significantly different between the groups. Univariate analysis identified number of D&C, endometrial thickness, duration of MPA administration, age of pregnancy permission (the age at which a patient was first allowed to attempt pregnancy after disappearance of the lesion), period of disappearance of lesions, and recurrence as independent variables.ResultsThe odds ratios (95 % confidence interval) of multivariate analysis for disease recurrence, endometrial thickness during ovulation, and age of pregnancy permission were 0.283 (0.102–0.785), 1.677 (1.251–2.248), and 0.889 (0.792–0.998), respectively. There was no significant difference in the other independent variables between groups.ConclusionsWe identified three factors considered to affect pregnancy establishment following conservative treatment with MPA: recurrence, endometrial thickness during ovulation, and the age of the pregnancy permission. Introduction of infertility treatment including assisted reproductive technology (ART) soon after achieving tumor disappearance by MPA would therefore be beneficial for patients with disease recurrence, thin endometrium, or a higher age of pregnancy permission.Electronic supplementary materialThe online version of this article (doi:10.1186/s12958-015-0136-7) contains supplementary material, which is available to authorized users.

Pregnancy and oncologic outcomes after fertility-sparing management for early stage endometrioid endometrial cancer

“…Osamu et al compared the clinicopathological variables between a pregnancy group (n=45) and a non-pregnancy group (n=53) after medroxyprogesterone acetate treatment for well-differentiated endometrial cancer or atypical endometrial hyperplasia. They discussed pregnancy-related factors: recurrence before conception, endometrial thickness during ovulation, and the age at which pregnancy was attempted 21. In our study, tumor grade seemed to be an important factor.…”

Fertility-preservation in endometrial cancer: is it safe? Review of the literature

“…Various doses of different progestational agents have been used in an effort to preserve fertility in patients with clinical stage I endometrial carcinoma. Oral medroxyprogesterone acetate (MPA) at a dose of 100-800 mg/day; megestrol acetate (MA) at a dose of 40-160 mg/day and a combination of tamoxifen and a progestin have been used with similar results (Zhou et al ., 2015; Inoue et al , 2016). The follow-up of these patients under conservative treatment in the first year included serial TVUS, endometrial biopsy and CA-125.…”

“…). As long as an accurate pretreatment assessment is performed, progestin therapy is an appropriate option to preserve fertility in young women with well-differentiated endometrial carcinoma or severe atypical endometrial hyperplasia (Pronin et al ., 2015; Inoue et al ., 2016). The absence of progesterone receptors (PR), however, can jeopardize the success of progestin as a treatment (Yang et al ., 2005).…”

Fertility outcomes in infertile women with complex hyperplasia or complex atypical hyperplasia who received progestin therapy and in vitro fertilization

“…Inoue et al (2016) identified three factors considered to affect pregnancy establishment following conservative treatment with MPA: recurrence, endometrial thickness during ovulation, and the age of the pregnancy permission. The common factors associated with IVF outcomes are listed in Table S1, including infertility type, BMI, etc.…”

“…Introduction of IVF soon after achieving tumor disappearance by MPA would therefore be beneficial for patients with disease recurrence, thin endometrium, or a higher age of pregnancy permission (Inoue et al, 2016). The implementation of IVF techniques not only increases the chance of conception, but it may also decrease the interval to conception (Gadducci et al, 2009).…”