Gynecology and Obstetrics Clinical Medicine (Dec 2021)

Pregnancy outcomes after fertility preservation in women with endometrial carcinoma and atypical endometrial hyperplasia: A systematic review and meta-analysis

  • Zerui Xiao,
  • Ziyi Song,
  • Jianliu Wang,
  • Huixin Liu,
  • Qun Lu

DOI
https://doi.org/10.1016/j.gocm.2021.07.004
Journal volume & issue
Vol. 1, no. 4
pp. 190 – 196

Abstract

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Objective: The objective of the study was to compare the effects of assisted reproductive technology (ART) and spontaneous pregnancy on pregnancy outcomes in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) following fertility-sparing treatments. Methods: Relevant studies published through July 2020 were identified from PubMed and Web of Science literature searches. The pregnancy outcomes of ART and spontaneous pregnancy were summarized and compared for women with complete remission of EC/AEH after fertility-sparing treatments. A subgroup analysis was performed based on whether patients had received in vitro fertilization and embryo transfer (IVF-ET) treatment. The complete remission and recurrence rates of EC/AEH following fertility-sparing treatments were estimated. The effect of pregnancy on recurrence rates of EC/AEH was also calculated. Results: Sixteen observational studies reporting pregnancy outcomes or recurrence with ART or spontaneous pregnancy for women with EC/AEH after fertility-sparing treatments were included. The complete remission rate of EC/AEH was 81.5% (95%CI, 78%–85%). Compared with spontaneous pregnancy, the pregnancy rate of ART was significantly higher (66.8% vs. 43.7%, OR ​= ​2.64, 95%CI 1.71–4.05, P<0.00001, I2 ​= ​14%). Subgroup analysis showed that the pregnancy rate of IVF-ET was significantly higher than that of spontaneous pregnancy (62.7% vs. 35.1%, OR ​= ​2.85, 95%CI 1.44-5.63, P ​= ​0.003, I2 ​= ​29%). The live birth rate of ART was significantly higher than that of spontaneous pregnancy (75.3% vs. 47.8%, OR ​= ​3.96, 95%CI1.76-8.77, P ​= ​0.0009, I2 ​= ​45%). The recurrence rate of EC/AEH was 31% (95%CI 24%–39%). Clinical pregnancy could reduce the recurrence rate of EC/AEH, but there was no significant evidence of an association. Conclusions: ART, especially IVF-ET, could significantly improve pregnancy outcomes in women with EC/AEH receiving fertility-sparing treatments. Following complete remission, ART treatment might be a better option for women with EC/AEH than spontaneous pregnancy.

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