ICSI outcome following conservative fertility sparing management of endometrial cancer

Approximately 5% of cases of endometrial cancer occur in women aged 40 years or younger. In the presence of early staged endometrial cancer, fertility sparing management may be considered in selected patients. Following high dose progestin therapy and confirmation of the regression of cancer, the patient might attempt to conceive spontaneously. However, assisted reproduction techniques might increase the likelihood of pregnancy and decrease the time interval to conception. In this report, the authors present four patients with endometrial cancer who were treated conservatively with high dose progestin. In all of the cases, the endo-myometrial junctional zone was intact with no evidence of extra-uterine spread on pelvic imaging. A total of seven intracytoplasmic sperm injection and embryo transfer cycles were performed in four patients; five healthy infants were delivered. Two additional spontaneous pregnancies occurred in two patients. During the follow-up period, no recurrence was noted. Although there are limited data, fertility sparing with high dose progestin therapy may be offered to patients with early stage disease and subsequently assisted reproductive techniques may be employed to achieve immediate pregnancy.