7952 Controlled Ovarian Stimulation with LNG-Ius in Situ in Women with Atypical Endometrial Lesions, Undergoing Fertility-Sparing Treatment

Abstract

<h3>Study Objective</h3> to demonstrate safety of ovarian stimulation with 52mg Levonorgestrel Intrauterine System (LNG-IUS) <i>in situ</i> in patients conservatively treated for atypical endometrial lesions <h3>Design</h3> prospective observational study. <h3>Setting</h3> <b>G</b>ynecology department of University Federico II, Naples, Italy. <h3>Patients or Participants</h3> young women with atypical endometrial hyperplasia (AEH),or FIGO IA G1-G2 endometrial cancer(EC-G1,EC-G2),who underwent fertility-sparing treatment and ovarian stimulation with LNG-IUS <i>in situ.</i> <h3>Interventions</h3> combined fertility-sparing treatment was performed:EC-G1 and EC-G2 were treated by three steps hysteroscopic technique, AEH by superficial endometrial resection. LNG-IUS was inserted after surgery. Hysteroscopic endometrial biopsies were performed at 3 and 6 months. If complete response (CR) was achieved, controlled ovarian stimulation with LNG-IUS <i>in situ</i> was started, oocytes retrieval performed, and mature oocytes cryopreserved. After removal of LNG-IUS, embryo transfer was performed. <h3>Measurements and Main Results</h3> 23 young women with AEH(n=17), EC-G1(n=3), or EC-G2(n=3) were enrolled. CR was achieved in 14/16(87.5%) of AEH, 2/2(100%) of EC-G1 and 2/3(66.7%) of EC-G2 at 3-month follow up and in 11/14(78.6%) of AEH, 2/2(100%) of EC-G1 and 2/2(100%) of EC-G2 at 6-month follow up. 10 patients underwent ovarian stimulation with LNG-IUS <i>in situ</i> (experimental group) and compared with 10 infertile patients undergoing ovarian stimulation in absence of LNG-IUS (control group). The mean number of oocytes retrieved and mature oocytes was 8.10(± 2.77 SD) and 7.00(± 2.11 SD) in experimental group, compared with 6.30(± 3.3 SD) and 4.88(± 2.68 SD) in control group. There were no statistically significant differences in oocytes retrieved(p=0.19) and mature oocytes(p=0.05) between the two groups. Reproductive outcome (pregnancies and live birth rate) was also assessed. Pregnancy rate was 50%, live birth rate 37.5% and miscarriage rate 12.5%; 50% of patients experienced implantation failure. <h3>Conclusion</h3> presence of LNG-IUS during ovarian stimulation has no negative effects on oocyte quality, balancing the potentially dangerous effect of hyperestrogenism on patients with atypical endometrial lesions. The combined approach confirmed as a safe and effective fertility-sparing approach. Promising pregnancy outcomes can be expected.