Oncologic and Pregnancy Outcomes of a Fertility Sparing Treatment in Endometrial Cancer: A Single Center Experience

PurposeThere has also been an increase in number of women with endometrial carcinoma (EC) in their reproductive years who wish to retain their fertility. We aimed to report the treatment results in EC patients underwent fertility-sparing treatment in Iran.MethodsThis is a case-series study conducted on women diagnosed with stage IA, grade 1 EC. Treatment was initiated using either megestrol acetate, medroxyprogesterone acetate (MPA) or MPA and metformin. Patients showing partial remission or disease persistence continued their hormone therapy and those showing disease persistence after 12 months or showing disease progression underwent the standard surgical intervention of hysterectomy and bilateral salpingo-oophorectomy. Bariatric surgery was also performed to improve overall prognosis in those indicated.ResultsOur study included 22 subjects, with a mean age of 32.82 +/- 5.46 years. Treatment results included complete remission in 10 (45.5%), relative remission in 2 (9.1%), persistence in 4 (18.2%) and disease progression in 6 (27.3%) subjects. 5 (22.7%) subjects had a spontaneous pregnancy and 13 (59.1%) underwent embryo cryopreservation. At 1-year timepoint, 8 (36.3%) subjects had a live birth, including 5 (22.7%) with a spontaneous pregnancy and 3 (13.6%) through a uterine surrogate. Side effects observed from hormonal therapy included weight gain (9.1%) and abnormal blood sugar and liver function tests (4.5%).ConclusionOverall, a conservative treatment approach to patients with EC aiming to preserve their fertility can be safe and have acceptable outcomes in terms of oncologic response as well as pregnancy results.