Park JiEun, Yu Eun Jeong, Lee Nara, Park Jae Eun, Seong Seok Ju, Lee Woo Sik, Lee Hee Jun
Fertility Center of CHA Gangnam Medical Center, College of Medicine, CHA University, Seoul, Republic of Korea.
CHA Fertility Center, Seoul Station, Seoul, Republic of Korea.
Gynecol Obstet Invest. 2024;89(6):461-468. doi: 10.1159/000539315. Epub 2024 May 22.
This study aimed to evaluate the clinical efficacy of fertility-preserving therapy through in vitro fertilization (IVF) procedures in women who were pathologically diagnosed with endometrial hyperplasia or carcinoma.
A retrospective cohort study on fertility-preserving therapy was conducted. Participants/Materials, Setting: A total of 82 women were enrolled who had simple endometrial hyperplasia (SH), complex hyperplasia (CH), complex atypical hyperplasia (CAH), and endometrioid endometrial carcinoma stage IA (EC IA) and underwent IVF at Gangnam CHA fertility center between January 2008 and December 2020.
The primary endpoints were oncologic outcomes and subsequent reproductive outcomes of patients who underwent fertility-preserving treatments analyzed by χ2 test or Fisher's exact test.
Of the 82 patients, 33 had a cumulative clinical pregnancy (40.2%), and 25 had a cumulative live birth (30.5%) through IVF procedures following pathologic confirmation of complete remission or non-progressive status. The cumulative clinical pregnancy rates and live birth rates for SH were 50.0% and 30.0%, for CH were 37.8% and 28.9%, for CAH were 25.0% and 25.0%, and for EC were 38.5% and 38.5%, respectively. There were no significant differences in cumulative clinical pregnancy rates or live birth rates when comparing the four groups. There was a difference in endometrial thickness between medroxyprogesterone acetate (MPA) treatment group and intrauterine device (IUD) group (p = 0.036); however, there were no significant differences in clinical pregnancy rates among MPA, IUD, and MPA+IUD groups.
Because of the retrospective nature of the study, many factors relevant to the treatment decision were not strictly controlled.
All endometrial hyperplasia and carcinoma groups had competent cumulative live birth rates by IVF procedures. There may be differences in endometrial thickness depending on the treatment methods, but this does not affect clinical pregnancy rates. Therefore, the fertility-preserving treatment for endometrial hyperplasia and carcinoma is a safe and feasible method that results in good IVF outcomes.
本研究旨在评估体外受精（IVF）程序在经病理诊断为子宫内膜增生或癌的女性中保留生育功能治疗的临床疗效。
进行了一项关于保留生育功能治疗的回顾性队列研究。参与者/材料、地点：共有82名患有单纯性子宫内膜增生（SH）、复杂性增生（CH）、复杂性不典型增生（CAH）和子宫内膜样腺癌IA期（EC IA）的女性在2008年1月至2020年12月期间于江南CHA生育中心接受了IVF治疗。
主要终点是接受保留生育功能治疗的患者的肿瘤学结局和随后的生殖结局，通过χ2检验或Fisher精确检验进行分析。
82例患者中，33例（40.2%）累积临床妊娠，25例（30.5%）在病理确认完全缓解或病情无进展后通过IVF程序累积活产。SH的累积临床妊娠率和活产率分别为50.0%和30.0%，CH分别为37.8%和28.9%，CAH分别为25.0%和25.0%，EC分别为38.5%和38.5%。比较这四组时，累积临床妊娠率或活产率无显著差异。醋酸甲羟孕酮（MPA）治疗组和宫内节育器（IUD）组的子宫内膜厚度存在差异（p = 0.036）；然而，MPA、IUD和MPA + IUD组之间的临床妊娠率无显著差异。
由于本研究的回顾性性质，许多与治疗决策相关的因素未得到严格控制。
所有子宫内膜增生和癌组通过IVF程序都有相当的累积活产率。根据治疗方法的不同，子宫内膜厚度可能存在差异，但这并不影响临床妊娠率。因此，子宫内膜增生和癌的保留生育功能治疗是一种安全可行的方法，可带来良好的IVF结局。
