Preserving fertility before assisted reproduction in women with endometrial carcinoma: case report and literature review

Abstract

Fertility-preserving treatment with progestin may be considered in nulliparous women with well-differentiated endometrial carcinoma. Recently, assisted reproductive treatments have been performed to achieve a rapid pregnancy in such cases. This report evaluates a 39-year-old woman who admitted with menorrhagia and primary infertility. Owing to persistent menstrual irregularity and thick endometrium, a diagnostic office hysteroscopy with endometrial biopsy was performed and revealed a well-differentiated adenocarcinoma. Although the woman wished to retain her childbearing potential with conservative management followed by an assisted reproduction cycle, the repeated endometrial biopsies during progestin treatment revealed persistent adenocarcinoma. Complementary surgery was performed due to persistent endometrial malignancy, which noted well-differentiated endometrioid adenocarcinoma without myometrial invasion or extrauterine disease. A review of cases with endometrial carcinoma that have been treated with conservative management and a subsequent assisted cycle is also presented here. To date, there are 14 such reports, including 15 women and 21 healthy infants. However, obtaining remission and maintaining the reproductive capability may not always be possible, even in early-stage cases. Therefore, patient and physician should always consider carefully if fertility-preserving management is preferred after diagnosis of endometrial carcinoma.

Endometrial cancer in a woman undergoing hysteroscopy for recurrent IVF failure

“…The cancer was also still present on the final specimen, meaning that it was not confined to the resected polypoid area, as often reported in the literature [12]. It seems therefore worth reminding that, although conservative treatment of early stage endometrial cancer by means of progestins and hysteroscopic resection has been proposed [9, 13], the gold standard includes a total hysterectomy [14]. In this case, following a patient-centered approach to care, the choice of undergoing hysterectomy was made by the patient after thorough information about different therapeutic alternatives.…”

Fertility-Sparing Management of Endometrial Adenocarcinoma

“…Available reproductive outcomes are derived from natural conception cycles, ovulation induction cycles with or without intrauterine insemination, and IVF cycles with or without intracytoplasmic sperm injection. 60,61,70,71,92,93 In the 2009 review by Tangjitgamol et al, 43 of 82 women with a documented CR and documented attempts at conception achieved 1 or more pregnancy. 61 These authors also reported 17 successful conceptions in the 40 women with recurrences and available follow-up data.…”

Gestational surrogacy after intra-operative oocyte collection in a hysterectomised woman diagnosed with endometrial cancer

“…Conservative management is occasionally considered in young nulliparous women who wish to preserve their reproductive potential, especially when they greatly desire their own genetic offspring. These women have undergone assisted conception techniques such as intrauterine insemination and in vitro fertilisation with successful pregnancy outcomes 11–14 …”

“…These women have undergone assisted conception techniques such as intrauterine insemination and in vitro fertilisation with successful pregnancy outcomes. [11][12][13][14] Important prognostic features for endometrial cancers are surgical FIGO stage, myometrial invasion, histological type and differentiation grade; most are independent of each other. 5 However, the idea of conservative management and moreover assisted conception in women diagnosed with endometrial cancer remains controversial even in very well-selected groups.…”