Fertility-Sparing Approach in Women Affected by Stage I and Low-Grade Endometrial Carcinoma: An Updated Overview

Abstract

Endometrial cancer (EC) is a deleterious condition which strongly affects a woman’s quality of life. Although aggressive interventions should be considered to treat high-grade EC, a conservative approach should be taken into consideration for women wishing to conceive. In this scenario, we present an overview about the EC fertility-sparing approach state of art. Type I EC at low stage is the only histological type which can be addressed with a fertility-sparing approach. Moreover, no myometrium and/or adnexal invasion should be seen, and lymph-vascular space should not be involved. Regarding the pharmaceutical target, progestins, in particular medroxyprogesterone acetate (MPA) or megestrol acetate (MA), are the most employed agent in conservative treatment of early-stage EC. The metformin usage and hysteroscopic assessment is still under debate, despite promising results. Particularly strict and imperious attention should be given to the follow-up and psychological wellbeing of women, especially because of the double detrimental impairment: both EC and EC-related infertility consequences.

Biomolecular and Genetic Prognostic Factors That Can Facilitate Fertility-Sparing Treatment (FST) Decision Making in Early Stage Endometrial Cancer (ES-EC): A Systematic Review

“…They should have no contraindications for medical treatment and a histological diagnosis of grade I EC; histotype: endometrioid with positive hormone receptor (type I), tumour diameter < 2.0 cm, stage IA without myometrial and adnexal involvement, negative lymph-vascular space invasion, and diffuse immunohistochemical expression of progesterone receptors on endometrial biopsy. These are the patients who are considered to be at “low risk” [ 83 ]. Furthermore, according to the Gynecologic Oncology Group (GOG) and Federation International of Gynecologic and Obstetrics (FIGO), the most important prognostic factors for lymph node metastasis in patients with EC were the grade of tumour and the depth of myometrial invasion with the risk of involvement less than 1% and excellent 5 year progression-free survival of 95% if the tumour is grade 1 with overall survival of 90%.…”

Psychological variables in medically assisted reproduction: a systematic review

“…Often, a multidisciplinary approach is undeniable [ 69 ]. Moreover, when approaching oncologic patients [ 70 , 71 ] who need fertility preservation, a similar medical behaviour should be considered [ 72 ]. A noticeable and futuristic medical approach should consider the collaboration of more diversified healthcare professional figures, who join together for the physical and mental wellness of patients.…”

Combined Preimplantation Genetic Testing for Genetic Kidney Disease: Genetic Risk Identification, Assisted Reproductive Cycle, and Pregnancy Outcome Analysis

“…In addition, cases of sperm and egg donation in various forms to reduce the risk of having children with genetic kidney disease were not included in this retrospective study (28). Fertility preservation for women with genetic kidney disease wishing to conceive is also not involved in our case (29,30). The applied range of PGT-M at the present stage still has limitations in some specific situation in our center.…”