Fertility outcomes with assisted reproductive technology after fertility-sparing treatment for endometrial neoplasia: a systematic review

Objective: To review the literature on the fertility outcomes for individuals using assisted reproductive technologies (ARTs) after fertility-sparing treatment (FST) for endometrial neoplasia. Answering this question has the potential to influence clinical practice, improve patient counseling, and guide further research. Evidence Review: Inclusion criteria were as follows: prospective and retrospective studies evaluating patients with complex atypical hyperplasia, endometrial intraepithelial neoplasia (EIN), or endometrial adenocarcinoma (EAC) who underwent FST, have a group or subgroup of patients who used ART, and discuss pregnancy-related outcomes for the ART cycles or proportion of patients using ART methods. Articles not in English were excluded. Four independent reviewers reviewed articles for inclusion. Twenty-five articles met the inclusion criteria, including 19 retrospective studies, 5 prospective studies, and 1 randomized control trial. Results: Assisted reproductive technology utilization among this population is high; although live birth rate per transfer is lower than expected, cumulative pregnancy rates approach what may be expected in other groups. Factors associated with success with in vitro fertilization (IVF) may include endometrial thickness >8 mm and shorter time to treatment after complete remission. Additionally, IVF does not increase mortality from EIN/EAC. Conclusion: Overall, this review demonstrated that ART can be an effective treatment option for individuals desiring fertility after FST for EIN/EAC; however, additional research is needed into pregnancy outcomes with ART methods after FST and the timing of treatment initiation. Providers should be diligent in referring individuals who desire pregnancy after FST to reproductive endocrinology and infertility services to increase the chances of pregnancy before disease recurrence. (c) 2023 by American Society for Reproductive Medicine.