2014 http://informahealthcare.com/gye ISSN: 0951-3590 (print), 1473-0766 (electronic) Gynecol Endocrinol, 2014; 30(4): 280–281 ! 2014 Informa UK Ltd. DOI: 10.3109/09513590.2014.892065 ENDOMETRIAL CANCER Efficacy of IVF following conservative management of endometrial cancer Diego Rossetti 1 , Giorgio Bogani 2 , Marco Carnelli 1 , Salvatore Giovanni Vitale 3 , Giuseppe Grosso 1 , and Luigi Frigerio 1 1 Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy, 2 Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy, and 3 Department of Obstetrics and Gynecology and Radiological Sciences, University of Catania, Catania, Italy Abstract Five cases of conservative management of early stage uterine carcinoma were reported. All patients successfully underwent in vitro fertilization (IVF). Role of conservative treatment, IVF and prophylactic surgery followed competition of parity was discussed. Keywords Conservative management, endometrial cancer, IVF, hysteroscopy, pregnancy History Received 18 September 2013 Revised 3 January 2014 Accepted 4 February 2014 Published online 25 February 2014 Introduction Endometrial cancer (EC) is the most common gynecological malignancy in developed countries [1]. However, since it affects prevalently postmenopausal women [1], medical literature is devoid of clear information regarding the best conservative approach for young patients. Owing the rarity of this condition (3–5% of the overall EC) no specific guidelines are still available [2]. Here, we present five cases of conservative management of early stage EC followed by in vitro fertilization (IVF) with 100% of childbearing, during the period 2005–2012. Cases Median age was 30 (27–31) years old and median BMI was 22 (20–23). All the patients were nulliparous and underwent to hysteroscopic biopsies for fertility problems. Pathology reports showed three G1 and two G2 endometrioid EC. All the specimens showed the presence of hormone receptors for estrogen and progesterone. A multidisciplinary counseling was carried by a multidisciplinary team. All the patients were strongly motivated to conserve their fertility. Magnetic resonance imaging (MRI) revealed the presence of endometrial lesions without signs of myometrium invasion in all cases. Additionally, all patients had unremarkable chest and abdominal computed tomography scans. No enlarged nodes or parenchymal lesion were detected. Diagnostic laparoscopy with peritoneal inspection and peritoneal washing was carried out in four patients (all examinations were unremarkable); while one patient refused surgery. Patients were treated with megestrol acetate (MA) 160 mg/die continuatively for 6 months. At the end of the treatment, hysteroscopic biopsies did not show the presence of any cancer or hyperplasia. Assisted reproductive treatment was started using gonadotropin-releasing hormone analog for pituitary down-regulation. Ovarian stimula- tion performed using follicle-stimulating hormone and human chorionic gonadotrophin (hCG) according to the long-protocol regimen [3]. All patients achieved pregnancy at the first IVF. No complications were observed and all pregnancies were uncomplicated. One patient with a previous diagnosis of G2 EC underwent to a planned cesarean hysterectomy at 38 weeks of gestation for fetal podalic presentation. No cancer was observed in the specimen. The other four patients had physiological vaginal delivery. Conservative management based on follow-up according regular basis was attempt for every patient. However, 3 and 5 months after delivery endometrial biopsies showed the presence of G1 endometrioid EC in two patients. They underwent surgical treatment according to standard guidelines [4]. Definitive path- ology reports showed respectively stage IA-G2 and IB-G1 endometrioid EC (stage was defined in accord to the 2009 FIGO classification system [5]). All pelvic lymph nodes were negative for metastasis and no adjuvant therapy was administered. All patients were disease free after a median follow-up of 36 (range, 14–52) months. Two patients, who decided to maintain fertility, are current undergoing the second and the third cycles of IVF. Comments The management of early EC in young women remains contro- versial. Progestins such as medroxyprogesterone acetate, MA and levonorgestrel intrauterine system have been used as a fertility- sparing approach with different dose regimens. The overall response rate was 73% in a median time of 4 months (range 1–15 Address for correspondence: Diego Rossetti, MD, Department of Obstetrics and Gynecology, Papa Giovanni XXIII Hospital, Bergamo, Italy. Tel: +39 3493215811. Fax: +39 0352674958. E-mail: docrossetti@gmail.com