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The Influence of Infertility Treatment on the Prognosis of Endometrial Cancer and Atypical Complex Endometrial Hyperplasia

Ichinose, Mari MD*; Fujimoto, Akihisa MD, PhD*; Osuga, Yutaka MD, PhD*; Minaguchi, Takeo MD, PhD; Kawana, Kei MD, PhD*; Yano, Tetsu MD, PhD*; Kozuma, Shiro MD, PhD*

International Journal of Gynecological Cancer: February 2013 - Volume 23 - Issue 2 - p 288–293
doi: 10.1097/IGC.0b013e31827c18a1
Uterine Cancer

Introduction Many patients with endometrial cancer have no children when diagnosed, and thus are reluctant to undergo hysterectomy, hoping to preserve their fertility. Their requirement is met, at least partially, with high-dose medroxyprogesterone acetate that brings good response rate in the treatment of endometrial cancer in the early stage and atypical complex endometrial hyperplasia (EC/ACEH). Actually, a number of successful pregnancies after the conservative treatment have been reported. To conceive, many of them need infertility treatment because of ovulation disorders which might have induced the cancer with unopposed estrogens. However, on the other side, hyperestrogenic status caused by ovulation induction or controlled ovarian stimulation might promote the progression and the recurrence of the disease.

Objective This study aimed to assess the effectiveness and safety of infertility treatment after conservative therapy for EC/ACEH, to confirm the significance of fertility-sparing therapy.

Methods The patients with EC/ACEH who achieved complete response after high-dose medroxyprogesterone acetate were eligible for this retrospective study. Characteristics of the patients, whether they underwent infertility treatment, conceived, or relapsed, and the interval from complete response to conception or recurrence were retrospectively analyzed.

Results The clinical outcomes of 36 patients were investigated. Twenty-six of them desired to conceive soon after complete response. All of them underwent infertility treatment, and 16 women delivered healthy babies. Kaplan-Meyer curve and log-rank test analysis revealed that women who achieved live birth had a significantly lower risk of recurrence than those without live birth. There was not a significant difference between the patients with and without infertility treatment.

Conclusions Use of ovulation induction drugs after conservative treatment of endometrial cancer did not increase the recurrence of the disease. Moreover, resulting pregnancy seems to have an advantageous effect on the oncologic outcome.

*Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo; and †Department of Obstetrics and Gynecology, Graduate School of Comprehensive Human Science, University of Tsukuba, Tsukuba, Japan.

Address correspondence and reprint requests to Akihisa Fujimoto, MD, PhD, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. E-mail:

The authors declare no conflicts of interest.

Received August 7, 2012

Accepted November 1, 2012

Copyright © 2013 by IGCS and ESGO