Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia

Osamu Inoue, Toshio Hamatani, Nobuyuki Susumu, Wataru Yamagami, Seiji Ogawa, Takashi Takemoto, Akira Hirasawa, Kouji Banno, Naoaki Kuji, Mamoru Tanaka, Daisuke Aoki

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: Patients hoping to preserve their fertility receive conservative treatment with high-dose medroxyprogesterone acetate (MPA) for well-differentiated endometrioid adenocarcinoma (EC) or atypical endometrial hyperplasia (AEH). Such treatment generally involves frequent intrauterine operations, including dilation and curettage (D&C) and endometrial biopsy (EMB), which could result in endometritis, endometrial thinning, or intrauterine adhesion. In turn, any of these outcomes could adversely affect implantation and pregnancy development. The current study thus aimed to identify factors that might affect pregnancy following conservative treatment by MPA. Methods: We compared a pregnancy group (45 patients) with a non-pregnancy group (53 patients) of MPA-treated patients to evaluate the factors affecting clinical pregnancy establishment. We undertook a multivariate logistic regression analysis based on factors shown by univariate analysis to be significantly different between the groups. Univariate analysis identified number of D&C, endometrial thickness, duration of MPA administration, age of pregnancy permission (the age at which a patient was first allowed to attempt pregnancy after disappearance of the lesion), period of disappearance of lesions, and recurrence as independent variables. Results: The odds ratios (95 % confidence interval) of multivariate analysis for disease recurrence, endometrial thickness during ovulation, and age of pregnancy permission were 0.283 (0.102-0.785), 1.677 (1.251-2.248), and 0.889 (0.792-0.998), respectively. There was no significant difference in the other independent variables between groups. Conclusions: We identified three factors considered to affect pregnancy establishment following conservative treatment with MPA: recurrence, endometrial thickness during ovulation, and the age of the pregnancy permission. Introduction of infertility treatment including assisted reproductive technology (ART) soon after achieving tumor disappearance by MPA would therefore be beneficial for patients with disease recurrence, thin endometrium, or a higher age of pregnancy permission.

Original languageEnglish
Article number2
JournalReproductive Biology and Endocrinology
Volume14
Issue number1
DOIs
Publication statusPublished - Jan 15 2016
Externally publishedYes

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Endometrial Hyperplasia
Pregnancy Outcome
Endometrial Neoplasms
Fertility
Medroxyprogesterone Acetate
Pregnancy
Therapeutics
Recurrence
Ovulation
Uterine Diseases
Endometrioid Carcinoma
Endometritis
Dilatation and Curettage
Assisted Reproductive Techniques
Curettage
Endometrium
Infertility
Dilatation
Multivariate Analysis
Logistic Models

Keywords

  • Assisted reproductive technology
  • Atypical endometrial hyperplasia
  • Fertility-preserving therapy
  • High-dose medroxyprogesterone acetate
  • Infertility treatment
  • MPA
  • Well-differentiated endometrial cancer

ASJC Scopus subject areas

  • Reproductive Medicine
  • Endocrinology
  • Developmental Biology

Cite this

Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia. / Inoue, Osamu; Hamatani, Toshio; Susumu, Nobuyuki; Yamagami, Wataru; Ogawa, Seiji; Takemoto, Takashi; Hirasawa, Akira; Banno, Kouji; Kuji, Naoaki; Tanaka, Mamoru; Aoki, Daisuke.

In: Reproductive Biology and Endocrinology, Vol. 14, No. 1, 2, 15.01.2016.

Research output: Contribution to journalArticle

Inoue, Osamu ; Hamatani, Toshio ; Susumu, Nobuyuki ; Yamagami, Wataru ; Ogawa, Seiji ; Takemoto, Takashi ; Hirasawa, Akira ; Banno, Kouji ; Kuji, Naoaki ; Tanaka, Mamoru ; Aoki, Daisuke. / Factors affecting pregnancy outcomes in young women treated with fertility-preserving therapy for well-differentiated endometrial cancer or atypical endometrial hyperplasia. In: Reproductive Biology and Endocrinology. 2016 ; Vol. 14, No. 1.
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AU - Inoue, Osamu

AU - Hamatani, Toshio

AU - Susumu, Nobuyuki

AU - Yamagami, Wataru

AU - Ogawa, Seiji

AU - Takemoto, Takashi

AU - Hirasawa, Akira

AU - Banno, Kouji

AU - Kuji, Naoaki

AU - Tanaka, Mamoru

AU - Aoki, Daisuke

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KW - Well-differentiated endometrial cancer

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