Chen Jiazhou, Cheng Yali, Fu Wei, Peng Xiandong, Sun Xiaoxi, Chen Hua, Chen Xiaojun, Yu Min
Shanghai JIAI Genetics and IVF Institute, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China.
Shanghai Key Laboratory of Female Reproductive and Endocrine-Related Diseases, Shanghai, China.
Front Med (Lausanne). 2021 Jul 27;8:581927. doi: 10.3389/fmed.2021.581927. eCollection 2021.
To investigate the effectiveness and recurrence risk of different ovulation stimulation protocols in early-stage endometrioid endometrial cancer (EEC) and atypical endometrial hyperplasia (AEH) patients after successful fertility preserving treatment. A retrospective review of clinical files between June 2012 and July 2018. University hospital. Ninety seven women (74 AEH and 23 early-stage EEC patients) underwent fertilization (IVF) and frozen-thawed embryo transfer (FET) after successful fertility preserving treatment. All patients received megestrol acetate which was initiated immediately after AEH or EEC diagnosis by hysteroscopy. Fertility treatment was initiated after confirmation of complete response by two consecutive hysteroscopic evaluations and endometrium biopsy in a 3-month interval. Women with tubal factors underwent IVF treatment directly. Women who failed to conceive spontaneously within 12 months or after other infertility treatments like ovulation induction for 6 consecutive months or 2 consecutive artificial insemination failures were also offered IVF treatment. The clinical and laboratory embryo data, clinical pregnancy outcomes and endometrial disease recurrence rates. Compared with the standard regimen group, the good-quality embryo rate was higher in progestin primed ovarian stimulation (PPOS) regimen group ( = 0.034). Univariate analysis showed significant differences in age ( = 0.033), treatment time of endometrial lesions ( < 0.001), and duration of Gn treatment ( = 0.018) between the recurrent and non-recurrent groups. In the adjusted model of multivariate logistic regression analysis, the age ( = 0.014) at ovulation induction and treatment time of endometrial lesions ( < 0.001) were significantly correlated with the recurrence of endometrial disease. The PPOS protocol is a feasible and safe strategy to stimulate ovulation during IVF after fertility preservation therapy, and the age at ovulation induction and treatment time of endometrial lesions are two stable predictors of recurrence in endometrial diseases.
为研究不同排卵刺激方案对早期子宫内膜样腺癌（EEC）和非典型子宫内膜增生（AEH）患者在成功保留生育功能治疗后的有效性及复发风险。对2012年6月至2018年7月期间的临床档案进行回顾性分析。研究地点为大学医院。97名女性（74例AEH患者和23例早期EEC患者）在成功保留生育功能治疗后接受了体外受精（IVF）和冻融胚胎移植（FET）。所有患者在经宫腔镜诊断为AEH或EEC后立即开始接受醋酸甲地孕酮治疗。在连续两次宫腔镜评估及间隔3个月的子宫内膜活检确认完全缓解后开始生育治疗。输卵管因素导致不孕的女性直接接受IVF治疗。在12个月内未能自然受孕或在接受其他不孕治疗（如连续6个月的促排卵或连续2次人工授精失败）后仍未受孕的女性也接受IVF治疗。记录临床及实验室胚胎数据、临床妊娠结局和子宫内膜疾病复发率。与标准方案组相比，孕激素预处理卵巢刺激（PPOS）方案组的优质胚胎率更高（P = 0.034）。单因素分析显示复发组和非复发组在年龄（P = 0.033）、子宫内膜病变治疗时间（P < 0.001）和促性腺激素（Gn）治疗持续时间（P = 0.018）方面存在显著差异。在多因素logistic回归分析的校正模型中，促排卵时的年龄（P = 0.014）和子宫内膜病变治疗时间（P < 0.001）与子宫内膜疾病复发显著相关。PPOS方案是保留生育功能治疗后IVF期间刺激排卵的一种可行且安全的策略，促排卵时的年龄和子宫内膜病变治疗时间是子宫内膜疾病复发的两个稳定预测因素。
