The Influence of Pregnancy on the Prognosis of Endometrial Atypical Hyperplasia and Adenocarcinoma with Assisted Reproductive Technology after Fertility-Sparing Therapy: A Systematic Review and Meta-Analysis

Abstract

Objective: To evaluate live birth rates and the influence of pregnancy on the prognoses of young women (<40 years old) with early-stage endometrial cancer (EC) and atypical complex hyperplasia (AH) who were treated by conservative management followed by assisted reproductive technology (ART). Methods: A meta-analysis of observational studies with a random-or fixed-effects model as appropriate. Results: A study of 527 women from 23 studies included 201 women to assess how prognosis might be influenced by pregnancy. Analysis of no pregnancy studies as the reference group pointed to a statistically significant positive association between pregnancy and decreased risk for recurrence (RR) of 0.56, 95% confidence interval (CI): 0.37-0.84. Eighteen studies including 104 women enabled determination of live birth rates of women with earlystage EC (79 women) and AH (25 women) following treatment with conservative management followed by ART. For patients with AH, 25 women were treated with ART after pathological remission of disease. Thirteen women achieved intrauterine pregnancies, and nine had 10 live births, with a pooled live birth rate of 0.32 with insignificant heterogeneity (P = 0.925). For those with EC, 79 women were treated by ART, 61 by IVF-ET, 12 by IUI, and 6 by ICSI. Fifty-seven women had intrauterine pregnancies, and 45 had 52 live births, with a pooled live birth rate of 0.60 and insignificant heterogeneity (P = 0.923). Conclusions: Live birth rates were encouraging using ART in young women with EC or AH who desired fertility after conservative management. Resulting pregnancies could reduce recurrent risk of AH and EC. Additionally, minimizing the time interval between treatment termination and pregnancy was important.