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The optimal time for the initiation of in vitro fertilization and embryo transfer among women with atypical endometrial hyperplasia and endometrial carcinoma receiving fertility-sparing treatment

  • Gynecologic Endocrinology and Reproductive Medicine
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

Abstract

Objective

To explore the optimal time for initiating in vitro fertilization and embryo transfer (IVF-ET) in women with complete remission after fertility-sparing treatment for grade I endometrial cancer (EC) or atypical endometrial hyperplasia (AEH).

Patients and methods

Young women who demonstrated complete remission after fertility-sparing treatment for grade I EC or AEH and underwent IVF-ET treatment were included. A generalized estimating equation (GEE) was used to compare the outcomes of controlled ovarian hyperstimulation (COH) and embryo transfer at different times after discontinuing high-dose progesterone therapy, and patients were divided into three groups: ≤ 3 months (time 1), 3–9 months (time 2) and > 9 months (time 3).

Results

Thirty-seven women with complete remission after fertility-sparing treatment for grade I EC or AEH underwent 75 IVF-ET cycles. Regarding initiation of COH, 10 cycles for time 1, 31 cycles for time 2 and 34 cycles for time 3 were included. The odds ratios (95% confidence intervals) for the number of available embryos at time 2 and time 3 were 1.82 (1.08–3.08) and 2.45 (1.39–4.33), and those for the number of high-quality embryos at time 2 and time 3 were, respectively, 3.64 (1.34–9.87) and 3.62 (1.10–11.91), compared with that at time 1. Nineteen (51.4%) women had at least one clinical pregnancy and 13 (35.1%) women had live births. During a median follow-up period of 51 months (range 5–168 months), 10 (27.0%) women had disease relapse, with a median interval of 15.5 months (range 5–104 months).

Conclusion

Initiating IVF-ET 3 months after ceasing high-dose progesterone therapy can lead to better outcomes of controlled ovarian hyperstimulation for women with endometrial cancer or atypical endometrial hyperplasia.

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Funding

This work was supported by the National Key Technology R&D Program of China (no. 2019YFC1005200 and 2019YFC1005203).

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Author notes

  1. Ziyi Song and Huixin Liu have equal contributions to this work.

Authors and Affiliations

  1. Center of Reproductive Medicine, Peking University People’s Hospital, Beijing, 100044, China

    Ziyi Song, Zerui Xiao & Qun Lu

  2. Department of Clinical Epidemiology, Peking University People’s Hospital, Beijing, China

    Huixin Liu

  3. Department of Obstetrics and Gynecology, Peking University People’s Hospital, Beijing, China

    Rong Zhou & Jianliu Wang

  4. Peking University Clinical Research Institute, Peking University First Hospital, Beijing, 100191, China

    Haibo Wang

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  1. Ziyi Song
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Contributions

ZS: data curation, investigation, writing- original draft preparation; HL: software, validation, formal analysis; RZ: conceptualization, resources; ZX: data curation, investigation; JL: supervision, funding acquisition; QL: methodology, writing— reviewing and editing; HW: methodology, validation.

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Correspondence to Haibo Wang or Qun Lu.

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The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Ethical approval

This research study was conducted retrospectively from data obtained for clinical purposes. The Peking University People’s Hospital Research Ethics Committee has confirmed that no ethical approval is required.

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Song, Z., Liu, H., Zhou, R. et al. The optimal time for the initiation of in vitro fertilization and embryo transfer among women with atypical endometrial hyperplasia and endometrial carcinoma receiving fertility-sparing treatment. Arch Gynecol Obstet 305, 1215–1223 (2022). https://doi.org/10.1007/s00404-021-06320-3

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  • DOI: https://doi.org/10.1007/s00404-021-06320-3

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