Abstract
Objective: To investigate the effectiveness and recurrence risk of different ovulation stimulation protocols in early-stage endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients after successful fertility preserving treatment.Design: A retrospective review of clinical files between June 2012 and July 2018.Setting: University hospital.Patients: Ninety seven women (74 AEH and 23 early-stage EEC patients) underwent in vitro fertilization (IVF) and frozen-thawed embryo transfer (FET) after successful fertility preserving treatment. All patients received megestrol acetate which was initiated immediately after AEH or EEC diagnosis by hysteroscopy. Fertility treatment was initiated after confirmation of complete response by two consecutive hysteroscopic evaluations and endometrium biopsy in a 3-month interval. Women with tubal factors underwent IVF treatment directly. Women who failed to conceive spontaneously within 12 months or after other infertility treatments like ovulation induction for 6 consecutive months or 2 consecutive artificial insemination failures were also offered IVF treatment.Main Outcome Measure (s): The clinical and laboratory embryo data, clinical pregnancy outcomes and endometrial disease recurrence rates.Results: Compared with the standard regimen group, the good-quality embryo rate was higher in progestin primed ovarian stimulation (PPOS) regimen group (P = 0.034). Univariate analysis showed significant differences in age (P = 0.033), treatment time of endometrial lesions (P < 0.001), and duration of Gn treatment (P = 0.018) between the recurrent and non-recurrent groups. In the adjusted model of multivariate logistic regression analysis, the age (P = 0.014) at ovulation induction and treatment time of endometrial lesions (P < 0.001) were significantly correlated with the recurrence of endometrial disease.Conclusions: The PPOS protocol is a feasible and safe strategy to stimulate ovulation during IVF after fertility preservation therapy, and the age at ovulation induction and treatment time of endometrial lesions are two stable predictors of recurrence in endometrial diseases.
Highlights
Endometrioid endometrial cancer (EEC) is mostly associated with long-lasting estrogen exposure without progesterone protection due to ovulation disorders
A total of 97 patients (23 cases diagnosed with early-stage EEC and 74 with atypical endometrial hyperplasia (AEH)) who had undergone different ovulation stimulation regimens were included in this study
The first oocyte retrieval cycle of each patient was included in the retrospective analysis; we collected 37 cycles in progestin primed ovarian stimulation (PPOS) protocol, 32 cycles in mild stimulation protocol (CC/LE+Gn), and 28
Summary
Endometrioid endometrial cancer (EEC) is mostly associated with long-lasting estrogen exposure without progesterone protection due to ovulation disorders. Fertility preserving treatment is an optional choice for certain young patients with early-stage EEC or AEH who strongly desire to preserve their fertility. The response rate of fertility preserving treatment of EEC and AEH patients is relatively satisfactory (80–90%), the pregnancy rate and live birth rate of these patients are still unsatisfactory [2, 3]. The combination of in vitro fertilization (IVF) and frozen-thawed embryo transfer (FET) is among the main methods for improving the pregnancy rate of EEC and AEH patients [6]. Most importantly, ovulation induction during infertility treatment may stimulate the ovarian production of 17β-estradiol (E2), which may promote the progression of EEC and AEH or induce their recurrence [8, 9]. Due to the relatively limited number of EEC and AEH patients receiving ovarian stimulation, there is no report on the effectiveness and recurrence risk of different ovarian stimulation protocols in EEC and AEH patients
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