OBJECTIVE: To analyze pregnancy outcomes in young women with stage IA, grade 1 endometrioid adenocarcinoma of the uterus after successful fertility-sparing management using progestin.
METHODS: We reviewed the medical records of 141 women with stage IA, grade 1 endometrioid adenocarcinoma of the uterus who had complete remission after progestin treatment. Statistical analysis was performed using Student’s t test or Mann-Whitney U test for continuous variables, using χ2 or Fisher’s exact test for categorical variables, and using log-rank test for survival comparison.
RESULTS: Fifty-four (38.3%) women in the study cohort had a history of infertility. Seventy (49.6%) of the 141 patients tried to conceive with 44 (62.9%) receiving fertility drugs. The median interval to attempted pregnancy after treatment was 5 months (range 1–31 months). The median age at the time of the pregnancy trial was 32.4 years (range 23–40 years). Fifty-one (73%) of 70 women who tried to conceive were successful and 46 (66%) gave birth to 58 live neonates. The spontaneous abortion rate, ectopic pregnancy rate, and preterm delivery rates in our cohort were 24%, 2.8%, and 11.5%, respectively. The 5-year disease-free survival was similar between patients who received fertility drugs (n=44) or who did not (n=97) (73% compared with 62%, P=.335), and this rate was significantly higher in patients who achieved at least one pregnancy (n=51) than those who did not (n=90) (76% compared with 62%, P=.028).
CONCLUSIONS: Although the proportion of patients with a history of subfertility or infertility was high in our cohort, the pregnancy outcomes were very promising using assisted reproductive technology. The use of fertility drugs was not associated with a higher incidence of cancer recurrence after successful fertility-sparing management in this study population.
LEVEL OF EVIDENCE: II
Pregnancy outcomes after the use of assisted reproductive technology are very promising, and using fertility drugs does not appear to increase cancer recurrence.
Departments of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Gangnam CHA Medical Center, CHA University, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul National University College of Medicine, and Samsung Medical Center, Sungkyunkwan University of Medicine, Seoul, and Chonnam National University, School of Medicine, Gwangju, Korea.
Corresponding author: Joo-Hyun Nam, MD, PhD, Department of Obstetrics and Gynecology, College of Medicine, University of Ulsan, Asan Medical Center, #388-1 Poongnap-2 dong, Songpa-gu, Seoul, 138-736, Korea; e-mail: email@example.com.
Supported by the Korean Gynecologic Oncology Group.
Financial Disclosure The authors did not report any potential conflicts of interest.