2085 Conservative Management of Endometrial Carcinoma and Precursor Lesions Preceding IVF Treatment: A Case Series

Abstract

Study Objective To share outcomes in our institution of patients who have undergone conservative management of endometrial carcinoma and its precursors for the sake of preserving fertility. Design Case-series. Setting Outpatient infertility clinic. Patients or Participants Six patients with variable characteristics, endometrial cancer or pre-cancer lesions diagnosed at the time of infertility workup. Age range is 31-42 years who have a diagnosis of complex hyperplasia with atypia or type I endometrial carcinoma following hysteroscopy D&C. Risk factors include primary infertility, PCOS and increasing age. Interventions All the patients were treated in conjunction with a Gynecologic Oncology specialist. The patients all received a form of progesterone therapy with either megestrol acetate or a levonorgestrel IUD. All patients obtained serial surveillance in the form of endometrial biopsy and/or D&C. Following resolution of the pathology, the patients were offered IVF in order to shorten the duration of time between IVF and a successful conception of pregnancy. Five patients underwent one cycle of IVF-ET. Measurements and Main Results One patient ended in no transfer as preimplantation genetic screen revealed all embryos to be abnormal. Four patients had embryo transfer and three conceived, two delivered and one pregnancy is ongoing. Conclusion Endometrial cancer, specifically type I endometrioid adenocarcinoma and its precursor lesions are strongly associated with unopposed estrogen states such as polycystic ovarian syndrome (PCOS), obesity as well as nulliparity. Patients seeking assisted reproductive technologies make up a subset of these patients and strongly desire to maintain their fertility. Progesterone therapy for select patients may be a safe and effective temporary treatment for endometrial carcinoma and atypical precursor lesions prior to starting IVF-ET. IVF-ET is very effective in treating such patients.