Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Haidian District, No. 49 North Huayuan Road, Beijing, 100191, China.
National Clinical Research Center for Obstetrics and Gynecology, Beijing, 100191, China.
Arch Gynecol Obstet. 2023 Dec;308(6):1845-1852. doi: 10.1007/s00404-023-07170-x. Epub 2023 Sep 1.
To evaluate the efficacy of levonorgestrel-releasing intrauterine device (LNG-IUD) during controlled ovarian stimulation (COS) in patients with early-stage endometrioid endometrial cancer (EEC).
A retrospective study was conducted on patients with stage IA1 EEC who achieved complete response after fertility-sparing treatment from December 2018 to December 2021, with all the women who underwent COS having LNG-IUDs inserted in their uterine cavity.
16 patients were enrolled who underwent 26 COS cycles and average age was 33.19 ± 4.04 years. 12 patients had 19 subsequent frozen-thawed embryo transfer (FET) cycles. Among the other four patients, no embryos were obtained in 1 patient, 1 patient got pregnancy spontaneously with term delivery after COS, 1 patient relapsed before FET, and 1 patient did not receive embryo transfer for personal reason. Among 19 FET cycles, the clinical pregnancy and live birth rates in each ET cycle were 36.84% (7/19) and 26.32% (5/19), respectively. 7 clinical pregnancies resulted in 2 miscarriages (28.6%), and 5 live births (71.4%). Totally 6 patients achieved 7 live births, and the cumulative live birth rate was 37.5% (6/16). Three (18.75%) out of 16 patients relapsed after COS during the follow-up period (31.31 ± 15.89 months) and two of them were initially diagnosed with moderately differentiated EEC. Time interval from COS to relapse was 6.63,11.67 and 16.23 months, respectively.
The combination of LNG-IUD treatment and segmented IVF may be a viable treatment strategy to improve oncological and reproductive outcomes for patients with early-stage EEC.
评估左炔诺孕酮宫内节育器（LNG-IUD）在接受控制性卵巢刺激（COS）的早期子宫内膜样腺癌（EEC）患者中的疗效。
对 2018 年 12 月至 2021 年 12 月接受生育保留治疗后达到完全缓解的 IA1 期 EEC 患者进行回顾性研究，所有接受 COS 的患者均将 LNG-IUD 置入宫腔。
共纳入 16 例患者，行 26 个 COS 周期，平均年龄为 33.19±4.04 岁。12 例患者行 19 个冻融胚胎移植（FET）周期。其余 4 例中，1 例未获得胚胎，1 例在 COS 后自然妊娠足月分娩，1 例在 FET 前复发，1 例因个人原因未行胚胎移植。在 19 个 FET 周期中，每个 ET 周期的临床妊娠率和活产率分别为 36.84%（7/19）和 26.32%（5/19）。7 例临床妊娠中 2 例流产（28.6%），5 例活产（71.4%）。共 6 例患者获得 7 例活产，累积活产率为 37.5%（6/16）。16 例患者中有 3 例（18.75%）在随访期间（31.31±15.89 个月）接受 COS 后复发，其中 2 例最初诊断为中分化 EEC。COS 至复发的时间间隔分别为 6.63、11.67 和 16.23 个月。
LNG-IUD 治疗联合分段 IVF 可能是一种可行的治疗策略，可改善早期 EEC 患者的肿瘤学和生殖结局。
