The outcome of infertility treatment in patients undergoing assisted reproductive technology after conservative therapy for endometrial cancer

Fujimoto, Akihisa; Ichinose, Mari; Harada, Miyuki; Hirata, Tetsuya; Osuga, Yutaka; Fujii, Tomoyuki

doi:10.1007/s10815-014-0297-x

Cited by 43 publications

(36 citation statements)

References 18 publications

(18 reference statements)

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“…Therefore, it is necessary to minimize damage to normal endometrium. To this end, Fujimoto et al [ 27 , 28 ] suggested that hysteroscopic resection of early stage EC combined with hormonal therapy might be more effective than endometrial curettage for eliminating lesions in such patients hoping to preserve their fertility. Such an approach would minimize a specimen, but does not increase the risk of peritoneal dissemination [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

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

Inoue

Hamatani

Susumu

et al. 2016

Reprod Biol Endocrinol

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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.

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Section: Discussionmentioning

confidence: 99%

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

Inoue

Hamatani

Susumu

et al. 2016

Reprod Biol Endocrinol

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“…The authors recommend that such patients should undergo fertility examinations and treatment as soon as possible after MPA therapy. Various studies have reported successful deliveries after conservative treatment . In addition, some studies have indicated that fertility treatment after conservative treatment for EC or AH results in better pregnancy outcomes, compared with expectant management; however, the sample sizes of these studies were small and the accumulation of further studies is needed in order to allow firm conclusions to be drawn.…”

Section: Introductionmentioning

confidence: 99%

Pregnancy outcomes of women who received conservative therapy for endometrial carcinoma or atypical endometrial hyperplasia

Matsuzaki

Iwasa

Kawakita

et al. 2018

Reprod Medicine & Biology

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CaseApproximately 3%‐25% of cases of endometrial carcinoma (EC) or atypical endometrial hyperplasia (AH) occur in women aged <40 years and conservative treatment with high‐dose medroxyprogesterone acetate (MPA) is administered to women who wish to preserve their fertility. Here is reported the pregnancy outcomes of patients with EC or AH who received MPA therapy at Tokushima University Hospital, Tokushima, Japan. The frequency of pregnancy and live births among the patients with EC or AH who received conservative treatment, followed by fertility treatment, were analyzed retrospectively.OutcomeTwelve patients underwent fertility examinations and received fertility treatment immediately after the completion of conservative treatment for EC or AH. One patient had the complication of severe diabetes and total embryo cryopreservation was performed before her diabetes was treated. Among the other 11 patients, 8 (72.7%) became pregnant at least once and 6 (54.5%) experienced at least 1 live birth. Three patients (25.0%) suffered disease recurrence during or after the infertility treatment and all of the recurrences occurred in the EC cohort.ConclusionWhen patients with EC or AH wish to preserve their fertility, it is recommended that prompt and effective fertility treatment, including assisted reproductive technology, should be initiated just after conservative treatment because EC and AH exhibit relatively high recurrence rates among conservatively treated patients.

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“…There are reports of many pregnancies after conservative management of endometrial carcinoma, some after ART (Fujimoto et al ., 2014; Koskas et al ., 2014) Combining conservative treatment with ART may result in healthy infants without an adverse effect on oncologic prognosis (Elizur et al. , 2007; Bozdag et al, 2009; Mao et al .,2010).…”

Section: Introductionmentioning

confidence: 99%

“…Ovulation induction does not appear to be associated with increased risk of relapse, and subsequent pregnancies do not worsen oncological outcomes (Matthews et al ., 2012; Fujimoto et al ., 2014; Zapardiel et al ., 2016). The impact of high serum estradiol levels on endometrial carcinoma is uncertain, although some data suggest an adverse effect of ovarian stimulation.…”

Section: Introductionmentioning

confidence: 99%

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

Carneiro

Lamaita

Ferreira

et al. 2016

JBRA Assisted Reproduction

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Almost 5% of women with endometrial cancer are under age 40, and they often have well-differentiated endometrioid estrogen-dependent tumors. Cancer survival rates have improved over the last decades so strategies to avoid or reduce the reproductive damage caused by oncologic treatment are needed. We reviewed the published literature to find evidence to answer the following questions: How should we manage women in reproductive age with endometrial cancer? How safe is fertility preservation in endometrial cancer? Can pregnancy influence endometrial cancer recurrence? What are the fertility sparing options available? Progestins may be prescribed after careful evaluation and counseling. Suitable patients should be selected using imaging methods and endometrial sampling since surgical staging will not be performed. Conservative treatment should only be offered to patients with grade 1 well-differentiated tumors, absence of lymph vascular space invasion, no evidence of myometrial invasion, metastatic disease or suspicious adnexal masses, and expression of progesterone receptors in the endometrium. The presence of co-existing ovarian metastatic of synchronous cancer should be investigated and ruled out before the decision to preserve the ovaries. The availability of Assisted Reproductive Technology (ART) has made it possible for women with endometrial cancer to give birth to a child without compromising their prognoses. Gamete, embryo or ovarian tissue cryopreservation techniques can be employed, although the latter remains experimental. Unfortunately, fertility preservation is rarely considered. Current recommendations for conservative management are based on the overall favorable prognosis of grade 1 minimally invasive tumors. Selected patients with endometrial cancer may be candidates to a safe fertility-preserving management.

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The outcome of infertility treatment in patients undergoing assisted reproductive technology after conservative therapy for endometrial cancer

Cited by 43 publications

References 18 publications

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

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

Pregnancy outcomes of women who received conservative therapy for endometrial carcinoma or atypical endometrial hyperplasia

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

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