A Successful Live Birth Through in vitro Fertilization Program After Conservative Treatment of FIGO Grade I Endometrial Cancer

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Abstract

Infertile women with chronic anovulation are prone to be exposed to unopposed estrogen stimulation and have the high risk of being suffering from endometrial hyperplasia or even endometrial carcinoma. A few reports have suggested that nulliparous young women (under 40 yr of age) with endometrial carcinoma could be treated conservatively to preserve fertility and succeed the live birth. We report on a 36-yr-old woman who received conservative treatment of endometrial carcinoma (stage I, grade 1) by curettage and progestin. After megestrol medication of total 71,680 mg during 24 weeks, we found the regression of endometrial lesion by curettage and hysteroscopic examination. Then we decided to perform in vitro fertilization program. Two embryos were transferred and heterotypic pregnancy was diagnosed 27 days after embryo transfer. After right salpingectomy, she received routine obstetrical care and delivered by cesarean section at 38 weeks in gestational periods. Two years after delivery, she is healthy without any evidence of recurrent disease. The fertility preserving treatment is an option in endometrial cancer patients if carefully selected, and assisted reproductive technologies would be helpful.

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Most cited references 18

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Population study of causes, treatment, and outcome of infertility.

Michele P Lambert, Ciarán Kelly, Joanne C. Coulson … (1985)

Specialist infertility practice was studied in a group of 708 couples within a population of residents of a single health district in England. They represented an annual incidence of 1.2 couples for every 1000 of the population. At least one in six couples needed specialist help at some time in their lives because of an average of infertility of 21/2 years, 71% of whom were trying for their first baby. Those attending gynaecology clinics made up 10% of new and 22% of all attendances. Failure of ovulation (amenorrhoea or oligomenorrhoea) occurred in 21% of cases and was successfully treated (two year conception rates of 96% and 78%). Tubal damage (14%) had a poor outlook (19%) despite surgery. Endometriosis accounted for infertility in 6%, although seldom because of tubal damage, cervical mucus defects or dysfunction in 3%, and coital failure in up to 6%. Sperm defects or dysfunction were the commonest defined cause of infertility (24%) and led to a poor chance of pregnancy (0-27%) without donor insemination. Obstructive azoospermia or primary spermatogenic failure was uncommon (2%) and hormonal causes of male infertility rare. Infertility was unexplained in 28% and the chance of pregnancy (overall 72%) was mainly determined by duration of infertility. In vitro fertilisation could benefit 80% of cases of tubal damage and 25% of unexplained infertility--that is, 18% of all cases, representing up to 216 new cases each year per million of the total population.

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Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40.

Robert Kurman, T Randall (1997)

To determine the efficacy of conservative management of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40. Pathology records were searched to identify women under age 40 diagnosed with atypical hyperplasia or well-differentiated carcinoma of the endometrium between January 1990 and January 1996. All available biopsy, curettage, and hysterectomy specimens were reviewed. Follow-up was obtained from the patients' gynecologists. Sixty-seven records were identified. Atypical hyperplasia was found in 32 patients and well-differentiated carcinoma in 35 patients. Seven patients were excluded from analysis; four declined all treatment and follow-up, and three received no further treatment or tissue sampling from their physicians. Among 27 remaining patients with atypical hyperplasia, eight underwent hysterectomy, two were treated with ovulation induction, and 17 were treated with progestins, of whom 16 had regression of their lesions, and one had a persistent lesion. Among 33 women with well-differentiated carcinoma, 19 underwent hysterectomy, one was treated with bromocriptine, one was treated with oral contraceptives, and 12 were treated with progestins, of whom nine had regression of their lesions and three had persistent lesions. The median length of treatment required for a regression was 9 months. At a mean follow-up of 40 months, all patients were alive and well without evidence of progressive disease. Twenty-five women attempted to become pregnant, and five delivered healthy, full-term infants. Treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium with progestins appears to be a safe alternative to hysterectomy in women under age 40.

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Progestin alone as primary treatment of endometrial carcinoma in premenopausal women. Report of seven cases and review of the literature.

F Montz, R K Nieberg, C H Holschneider … (1997)

The standard treatment for endometrial carcinoma is staging laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy. In an attempt to preserve childbearing potential, selected patients with endometrial carcinoma were treated with progestin alone as primary therapy. Patients were identified through searches of tumor registries and solicitation of consulting gynecologic oncologists at the affiliated institutions of the University of California-Los Angeles Center for the Health Sciences. Only those patients with a diagnosis of endometrial carcinoma treated with progestin alone as primary therapy were included in the study. Independent pathologic review was performed by a recognized expert gynecologic pathologist to exclude cases of endometrial hyperplasia. A MEDLINE search was conducted to identify reports of similarly treated patients. Seven patients were treated with progestin alone for endometrial carcinoma at the study institution. Fourteen additional patients were identified through the literature search. Combining the data for all patients, 13 of 21 patients (62%) had an initial response to progestins. Three initial responders later developed recurrent disease, one of whom was found to have extrauterine disease at laparotomy. Eight of 21 patients (38%) did not respond to progestins and underwent more definitive treatment. None of these patients later developed recurrent disease. Six viable infants were delivered of three patients after therapy. Nineteen of 21 patients were alive without evidence of disease at last follow-up. The results of this study show that premenopausal women with endometrial carcinoma may be treated successfully with progestin therapy alone as primary therapy to preserve childbearing potential.

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Author and article information

Journal

Journal ID (nlm-ta): J Korean Med Sci

Journal ID (publisher-id): JKMS

Title: Journal of Korean Medical Science

Publisher: The Korean Academy of Medical Sciences

ISSN (Print): 1011-8934

ISSN (Electronic): 1598-6357

Publication date (Print): June 2006

Publication date (Electronic): 21 June 2006

Volume: 21

Issue: 3

Pages: 567-571

Affiliations

Department of Obstetrics and Gynecology, Keimyung University, School of Medicine, Daegu, Korea.

Author notes

Address for correspondence: Jeong-Ho Rhee, M.D. Department of Obstetrics and Gynecology, Keimyung University, School of Medicine, 194 Dongsan-dong, Jung-gu, Daegu 700-712, Korea. Tel: +82.53-250-7871, Fax: +82.53-250-7599, rl670416@ 123456dsmc.or.kr

Article

DOI: 10.3346/jkms.2006.21.3.567

PMC ID: 2729970

PubMed ID: 16778408

SO-VID: a889f79b-53cf-4630-896e-902ac7335d09

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

A Successful Live Birth Through in vitro Fertilization Program After Conservative Treatment of FIGO Grade I Endometrial Cancer

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Abstract

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Most cited references 18

Population study of causes, treatment, and outcome of infertility.

Progestin treatment of atypical hyperplasia and well-differentiated carcinoma of the endometrium in women under age 40.

Progestin alone as primary treatment of endometrial carcinoma in premenopausal women. Report of seven cases and review of the literature.

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