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

Li, Miao; Song, Jialun; Zhao, Ying; Wu, Sheling; Liu, Hongbin; Tang, Rong; Yan, Lei

doi:10.1631/jzus.b1600523

Cited by 13 publications

(8 citation statements)

References 14 publications

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“…Endometrial carcinoma is the most common malignancy of the female genital tract in the United States [ 1 ]. Despite its prevalence, few studies have focused on the pregnancy outcomes after ART in patients who underwent FST [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ]. We found that patients with EMCA/EH who underwent embryo transfer after FST had significantly lower live birth rates when compared to matched controls at our center.…”

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment and Assisted Reproductive Technology in Patients with Endometrial Carcinoma and Endometrial Hyperplasia: Pregnancy Outcomes after Embryo Transfer

Friedlander

Blakemore

McCulloh

et al. 2023

Cancers

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The goal of fertility-sparing treatment (FST) for patients desiring future fertility with EMCA, and its precursor EH, is to clear the affected tissue and revert to normal endometrial function. Approximately 15% of patients treated with FST will have a live birth without the need for assisted reproductive technology (ART). Despite this low number, little information exists on the pregnancy outcomes of patients who utilize ART. The purpose of this study was to evaluate pregnancy outcomes following embryo transfer in patients with EMCA or EH who elected for FST. This retrospective cohort study at a large urban university-affiliated fertility center included all patients who underwent embryo transfer after fertility-sparing treatment for EMCA or EH between January 2003 and December 2018. Primary outcomes included embryo transfer results and a live birth rate (defined as the number of live births per number of transfers). There were 14 patients, three with EMCA and 11 with EH, who met the criteria for inclusion with a combined total of 40 embryo transfers. An analysis of observed outcomes by sub-group, compared to the expected outcomes at our center (patients without EMCA/EH matched for age, embryo transfer type and number, and utilization of PGT-A) showed that patients with EMCA/EH after FST had a significantly lower live birth rate than expected (Z = −5.04, df = 39, p < 0.01). A sub-group analysis of the 14 euploid embryo transfers resulted in a live birth rate of 21.4% compared to an expected rate of 62.8% (Z = −3.32, df = 13, p < 0.001). Among patients with EMCA/EH who required assisted reproductive technology, live birth rates were lower than expected following embryo transfer when compared to patients without EMCA/EH at our center. Further evaluation of the impact of the diagnosis, treatment, and repeated cavity instrumentation for FST is necessary to create an individualized and optimized approach for this unique patient population.

show abstract

Section: Discussionmentioning

confidence: 99%

Fertility-Sparing Treatment and Assisted Reproductive Technology in Patients with Endometrial Carcinoma and Endometrial Hyperplasia: Pregnancy Outcomes after Embryo Transfer

Friedlander

Blakemore

McCulloh

et al. 2023

Cancers

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show abstract

“…Endometrial carcinoma is the most common malignancy of the female genital tract in the United States 1 . Despite its prevalence, few studies have focused on the pregnancy outcomes after ART in patients who underwent FST [18][19][20][21][22][23][24][25] . We found that patients with EMCA/EH who underwent embryo transfer after FST, had signi cantly lower live birth rates when compared to matched controls at our center.…”

Section: Discussionmentioning

confidence: 99%

“…Our results supplement prior research. Two studies have shown a low live birth rate in patients with EMCA/EH after ART: a) a case series examining IVF cycles in patients with stage IA endometrial adenocarcinoma who underwent FST reported a cumulative clinical pregnancy rate of 50.0% and a live birth rate of 27.3%20 and b) a retrospective analysis of patients with EH who received FST and IVF had a clinical pregnancy rate of 50.0% and a live birth rate of 38.0%21 . Interestingly, a case series by Elizur et al, which evaluated IVF outcomes in women conservatively treated for endometrial adenocarcinoma, reported that 75.0% of women conceived and 50.0% delivered healthy offspring18 .…”

mentioning

confidence: 99%

Fertility-Sparing Treatment and Assisted Reproductive Technology In Patients With Endometrial Carcinoma And Endometrial Hyperplasia: Pregnancy Outcomes After Embryo Transfer

Friedlander

Blakemore

McCulloh

et al. 2021

Preprint

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Purpose: To evaluate pregnancy outcomes following embryo transfer in patients with endometrial carcinoma (EMCA) or endometrial hyperplasia (EH) who elected for fertility-sparing treatment (FST). Methods: This retrospective cohort study at a large urban university-affiliated fertility center included all patients who underwent embryo transfer after fertility-sparing treatment for EMCA or EH between January 2003 and December 2018. Primary outcomes included embryo transfer results and a live birth rate (defined as number of live births per number of transfers).Results: There were 14 patients, 3 with EMCA and 11 with EH, who met criteria for inclusion with a combined total of 40 embryo transfers. An analysis of observed outcomes by sub-group, compared to the expected outcomes at our center (patients without EMCA/EH matched for age, embryo transfer type and number, and utilization of PGT-A) showed that patients with EMCA/EH after FST had a significantly lower live birth rate than expected (Z = -5.04, df =39, p < 0.01). A sub-group analysis of the 14 euploid embryo transfers resulted in a live birth rate of 21.4% compared to an expected rate of 62.8% (Z = -3.32, df = 13, p < 0.001).Conclusions: Among patients with EMCA/EH who required assisted reproductive technology, live birth rates were lower than expected following embryo transfer when compared to patients without EMCA/EH at our center. Further evaluation of the impact of the diagnosis, treatment and repeated cavity instrumentation for FST is necessary to create an individualized and optimized approach for this unique patient population

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“…So in this study we did not include the endometrial thickness in our evaluation of the modeling effect. Preserving fertility after endouterine surgery is of great concern to clinicians and a causal relationship between endometrial surgery and infertility has been established based on retrospective studies (Schenker and Margalioth, 1982;de Ziegler et al, 2010;Cenksoy et al, 2013;Li et al, 2017). Thus, in contrast to previous studies, in addition to endometrial morphology and the number of endometrial glands, we included a fertility assessment in this study as a parameter for evaluating the animal model.…”

Section: Discussionmentioning

confidence: 99%

Creation of a rabbit model for intrauterine adhesions using electrothermal injury

Cao

Wang

et al. 2018

J. Zhejiang Univ. Sci. B

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The pathogenesis and therapeutic treatment of intrauterine adhesions (IUAs) remain unsolved, highlighting the need for stable and effective experimental animal models. In this study, uterine electrocoagulation of twenty-one female New Zealand White rabbits was carried out to establish an IUA model. As rabbits have two completely separate uterine horns, each rabbit had its own internal control: one uterine horn was given an electrothermal injury (Group A, n=21), and the contralateral uterine horn received no treatment and served as the control (Group B, n=21). The endometrial morphology, number of endometrial glands, area of endometrial fibrosis, and number of implanted fetuses were compared between the two groups. In Group A, the numbers of endometrial glands on Days 7 and 14 and the number of implanted fetuses were significantly lower than those in Group B (P<0.05, P<0.05, and P<0.01, respectively), while the ratio of the area with endometrial stromal fibrosis to the total endometrial area was significantly increased (P<0.01). These results suggest that this method of electrothermal injury is effective for the establishment of a rabbit IUA model between 7 and 14 d after surgery.

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

Cited by 13 publications

References 14 publications

Fertility-Sparing Treatment and Assisted Reproductive Technology in Patients with Endometrial Carcinoma and Endometrial Hyperplasia: Pregnancy Outcomes after Embryo Transfer

Fertility-Sparing Treatment and Assisted Reproductive Technology in Patients with Endometrial Carcinoma and Endometrial Hyperplasia: Pregnancy Outcomes after Embryo Transfer

Fertility-Sparing Treatment and Assisted Reproductive Technology In Patients With Endometrial Carcinoma And Endometrial Hyperplasia: Pregnancy Outcomes After Embryo Transfer

Creation of a rabbit model for intrauterine adhesions using electrothermal injury

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