Abstract
OBJECTIVE: To study the oncological safety and efficacy with regard to reproductive outcomes of controlled ovarian stimulation (OS) with levonorgestrel-releasing intrauterine system (LNG-IUS). DESIGN: Retrospective cohort study. SUBJECTS: Patients presenting with complex endometrial hyperplasia or early-stage endometrial carcinoma (EC), managed with levonorgestrel-releasing intrauterine system. EXPOSURE: Controlled OS. MAIN OUTCOME MEASURES: The primary outcome of the present study was to evaluate the oncological safety of controlled OS on disease progression, and the secondary outcome was to explore fertility outcomes in patients treated with LNG-IUS. Time-to-event outcomes were visualized as Kaplan-Meier plots and hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS: Thirty-four patients, with a median age of 34 years (interquartile range [IQR], 30-38) and body mass index of 29.6 kg/m(2) (IQR, 26-36.9), were included in our analysis. Of the patients, 76.5% were diagnosed with grade 1 EC, and 73.5% sought fertility counseling. The median anti-mullerian hormone level was 22.40 pmol/L (IQR, 8.7-55.9). Eleven patients underwent OS with a median peak estradiol level of 1,406 pmol/L (IQR, 694.0-9,577), median of 5 (IQR, 2-17) oocytes retrieved, and median of 4 (IQR, 1-6) embryos stored. There was no significant difference between patients who did and those who did not undergo OS in terms of recurrence (HR, 1.16 [95% CI, 0.36-3.76]) or disease upgrading (HR, 0.71 [95% CI, 0.13-3.97]) for the first 50 months after LNG-IUS placement. Eleven out of 34 (32.35%) patients attempted to conceive during the follow-up period; of those, 54% achieved a live birth (3 by spontaneous conception, 1 by assisted reproductive technology, and 2 by surrogacy with own embryos). CONCLUSION: There may be an oncologically safe window of opportunity for fertility preservation and conception for patients on LNG-IUS diagnosed with early-stage EC, wishing to complete their family.