A successful live birth with in vitro fertilization and thawed embryo transfer after conservative treatment of recurrent endometrial cancer

Abstract

Estrogen-dependent early stage endometrial cancer is relatively common in young women of reproductive age. The standard treatment is hysterectomy and bilateral salpingo-oophorectomy (BSO), even in early stage well-differentiated endometrial cancer patients. This surgical option results in permanent loss of fertility. There have been some reports of live births using in vitro fertilization after conservative management of endometrial cancer with high-dose progestin for the purpose of fertility preservation. However, most were not recurrent cases and pregnancy was achieved through conventional in vitro fertilization, which usually raises serum estradiol levels and may lead to the recurrence of endometrial cancer. To date, it is hard to find a case that can be referred for any possible different approach needed for the patients who experience recurrence. Here we report a successful live birth with in vitro fertilization using letrozole to maintain physiological levels of estradiol, and subsequent thawed embryo transfer after elective cryopreservation of embryos in a patient with recurrent endometrial cancer. There has been no evidence of disease recurrence at one year after delivery.

Chinese abstract

早期雌激素依赖性子宫内膜癌常见于育龄期年轻女性。即使是早期高分化子宫内膜癌患者, 该病的标准治疗方案依然是全子宫及双侧附件切除术（BSO）。而手术治疗将会导致女性生育能力的永久丧失。为保留女性生育力, 在对子宫内膜癌患者应用大剂量孕酮保守治疗后行体外受精进而成功分娩的案例不乏有报道。但大多数病例为非复发病例, 且以传统的体外受精方式妊娠通常会引发血清雌二醇水平升高, 从而可能导致子宫内膜癌复发。至今, 可作为复发性子宫内膜癌患者参考的方法案例仍鲜有报道。本文主要对一例复发性子宫内膜癌患者应用来曲唑维持雌二醇的生理水平后行冻融胚胎移植并成功分娩的案例进行报道, 该患者分娩后一年子宫内膜癌并无复发。

Keywords:

• Progestin
• assisted reproductive technology
• thawed embryo transfer
• letrozole
• recurrent endometrial cancer

Acknowledgments

This study was supported by grants of Ministry of Science, ICT and Future Planning (2016R1E1A1A01943455).

Disclosure statement

The authors report no conflicts of interest.