PurposeUterine adenosarcomas (UAs) account for 5–8% of cases of uterine sarcomas. Treatment includes total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO).Fertility preservation is an emerging concept in gynaecology oncology and is particularly relevant in UA, where cases are diagnosed as young as 15-year-old. This manuscript demonstrates a case of UA which was treated conservatively, achieved successful livebirths and underwent completion hysterectomy after two decades of follow-up.MethodThis was a retrospective case note review.ResultsAn 18-year-old nulliparous woman presented with abnormal vaginal bleeding. Ultrasound identified an endometrial polyp, which was histologically diagnosed as low-grade adenosarcoma. She was advised to undergo TAH and BSO, but instead decided to preserve her fertility and opted for conservative management. She was monitored with pelvic ultrasound, hysteroscopy and endometrial biopsy bi-annually, with annual pelvic magnetic resonance imaging for 10 years which was uneventful. 11 years post-operatively she conceived following in-vitro fertilization (IVF) but suffered a miscarriage at 16 weeks likely due to cervical incompetence. She subsequently conceived with twins. She delivered spontaneously preterm at 28 weeks. Both children are alive and well. After 20 years of follow-up, she underwent a laparoscopic hysterectomy with no evidence of recurrence. She remains disease free.ConclusionWhilst radical completion surgery should be advised in UA, this case, in addition to all published conservatively managed cases of UA, demonstrates that conservative management is possible in appropriately selected women. Intensive monitoring post-operatively is essential owing to the risk of recurrence; however, this may pose deleterious side effects which require consideration.

Given the increased risk of ovarian, breast, and endometrial cancers associated with nulliparity, there is a higher inherent cancer risk among patients pursuing fertility treatment (FT) than the general population. Endometrial and breast are hormone-sensitive cancers that carry elevated risk associated with estrogen predominant states including ovarian stimulation. Repeated ovulation causing disruption of ovarian epithelium may partially explain the elevated risk of ovarian cancer incurred by nulliparity. The rise in prevalence of FT has prompted the need for comprehensive evaluation of the association between FT and malignancy.This meta-analysis aimed to assess whether exposure to FT through ovulation induction, ovarian stimulation, and in vitro fertilization (IVF) increased risk of breast, ovarian, endometrial, or cervical cancer diagnosis. Several databases were queried up to December 2019 to identify articles comparing the incidence of endometrial, cervical, ovarian, and breast cancer among infertile patients that had undergone FT (FT cohort) to those that had not (control cohort). Peer-reviewed original studies published in English that defined the incidence of malignancy in treatment and control groups and FT including the use of clomiphene citrate, hMG, GnRH, gonadotrophins, and progestogens in various combinations were included. The primary study outcome was cancer incidence, both overall and per organ, in the FT group compared with the control group. The meta-analysis was performed according to MOOSE and PRISMA guidelines.The final meta-analysis included 29 retrospective studies of which 17 studies included multiple cancers, 19 studies investigated breast cancer, 19 studies investigated ovarian cancer, 15 studies investigated endometrial cancer, and 13 studies investigated cervical cancer. The total study population included 875,956 in the FT cohort and 20,194,381 in the control cohort, and when all patients were included, the difference in overall cancer diagnosis was not shown to be statistically significant (odds ratio [OR], 0.95; 95% confidence interval [CI], 0.82-1.10). There was not found to be a statistically significant difference between FT and breast cancer incidence (OR, 0.86; 95% CI, 0.73-1.01), ovarian cancer incidence (OR, 1.28; 95% CI, 0.92-1.79), or endometrial cancer incidence (OR, 1.28; 95% CI, 0.92-1.79). The difference in cervical cancer incidence between the FT and control cohort was statistically significant favoring the FT group (OR, 0.68; 95% CI, 0.46-0.99). Subgroup analysis of borderline ovarian cancers (OR, 1.69; 95% CI, 1.27-2.25), ovarian cancer among IVF-only FT patients (OR, 1.32; 95% CI, 1.03-1.69), and among clomiphene citrate-only FT patients (OR, 1.40; 95% CI, 1.10-1.77) did reveal a statistically significant increase in risk among the FT cohort. Subgroup analysis of IVF-only FT patients revealed a decrease in breast (OR, 0.75; 95% CI, 0.61-0.92) and cervical (OR, 0.58; 95% CI, 0.38-0.89) cancer risk.The results of this study indicate that FT exposure has no association...