JBRA Assisted Reproduction 2025;29(Suppl.2 SBRA 2025):111
Poster Presentation
29^th Annual Congress of the SBRA. São Paulo/SP - Brazil, 2025
doi: 10.5935/1518-0557.20263738

P-99. Fertility after conservative treatment of endometrial cancer in young women: a narrative review.

Endjeli Vogler Reche¹, Gabriela Souza Silva¹, Maria Clara Rodrigues¹, Gabriela Gimenez Ferrarini¹, Maria Mônica Pereira¹

¹ Centro Universitário São Camilo - São Paulo – SP – Brasil

Objective: This literature review aims to evaluate the effects of conservative management of endometrial cancer on fertility preservation in young women.
Methods: The search was conducted in the Medline (PubMed) and LILACS (BVS) databases using controlled descriptors (MeSH and DeCS) and the Boolean operators "AND" and "OR" in order to refine the results and appropriately combine the descriptors: "Endometrial Neoplasms" AND "Fertility Preservation" AND "Young Adult" OR "Adult" AND "Treatment Outcome" OR "Conservative Treatment". Filters were applied to include articles published from 2015 to 2025, in Portuguese, English, or Spanish. The initial search identified 18 articles, of which three were excluded: one duplicate, one due to a small sample size, and another for not directly addressing the proposed topic. The information extraction was performed using a standardized spreadsheet in Microsoft Excel and the collected information was: type of study, population characteristics, sample size, type and duration of interventions. The final sample included 15 studies, which supported the critical analysis and discussion.
Results: A total of 15 studies published between 2015 and 2025 were included: 6 observational studies, 1 cohort study, 2 case reports, 1 randomized controlled trial, 1 clinical trial, 2 systematic reviews, and 2 narrative reviews. Most studies demonstrated that hysteroscopic resection of the endometrial tumor lesion combined with hormonal therapy showed the best oncologic and reproductive outcomes in the treatment of endometrial cancer. This combined approach resulted in higher pregnancy rates and lower rates of tumor progression and the need for hysterectomy when compared to hormonal therapy or levonorgestrel-releasing intrauterine device (LNG-IUD) alone. Some studies also reported benefits from the use of metformin due to its antiproliferative properties on the endometrium; however, its clinical effectiveness still requires further validation. Regarding progestin-based agents, they were shown to be a viable therapeutic option for fertility preservation in young, premenopausal women with early-stage endometrial cancer. However, recurrence rates remain high, making close follow-up essential. Patients should be informed of the limitations and risks of conservative treatment, and after completing family planning, hysterectomy should be performed.
Conclusion: In conclusion, the therapeutic combination of hysteroscopic resection of the endometrial tumor lesion and hormonal therapy is associated with higher conception rates, as well as lower rates of tumor progression and the need for hysterectomy, when compared to hormonal therapy alone. However, there is a need for additional studies providing more consistent evidence regarding the efficacy of metformin, due to its potential antiproliferative properties on the endometrium, as well as of progestin-based agents as a fertility-preserving strategy in young premenopausal women with early-stage endometrial cancer. Finally, the importance of a patient-centered, shared decision-making approach is emphasized, ensuring that patients are fully informed about the risks, limitations, and prospects of conservative treatment, particularly in the context of reproductive planning.