Objective To explore the optimal time for initiating in vitro fertilization and embryo transfer (IVF-ET) in women with complete remission after fertility-sparing treatment for grade I endometrial cancer (EC) or atypical endometrial hyperplasia (AEH). Patients and methodsYoung women who demonstrated complete remission after fertility-sparing treatment for grade I EC or AEH and underwent IVF-ET treatment were included. A generalized estimating equation (GEE) was used to compare the outcomes of controlled ovarian hyperstimulation (COH) and embryo transfer at different times after discontinuing high-dose progesterone therapy, and patients were divided into three groups: ≤ 3 months (time 1), 3-9 months (time 2) and > 9 months (time 3). Results Thirty-seven women with complete remission after fertility-sparing treatment for grade I EC or AEH underwent 75 IVF-ET cycles. Regarding initiation of COH, 10 cycles for time 1, 31 cycles for time 2 and 34 cycles for time 3 were included. The odds ratios (95% confidence intervals) for the number of available embryos at time 2 and time 3 were 1.82 (1.08-3.08) and 2. 45 (1.39-4.33), and those for the number of high-quality embryos at time 2 and time 3 were, respectively, 3.64 (1.34-9.87) and 3.62 (1.10-11.91), compared with that at time 1. Nineteen (51.4%) women had at least one clinical pregnancy and 13 (35.1%) women had live births. During a median follow-up period of 51 months (range 5-168 months), 10 (27.0%) women had disease relapse, with a median interval of 15.5 months (range 5-104 months). Conclusion Initiating IVF-ET 3 months after ceasing high-dose progesterone therapy can lead to better outcomes of controlled ovarian hyperstimulation for women with endometrial cancer or atypical endometrial hyperplasia.

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ObjectiveThe objective of the study was to compare the effects of assisted reproductive technology (ART) and spontaneous pregnancy on pregnancy outcomes in women with endometrial carcinoma (EC) and atypical endometrial hyperplasia (AEH) following fertility-sparing treatments.MethodsRelevant studies published through July 2020 were identified from PubMed and Web of Science literature searches. The pregnancy outcomes of ART and spontaneous pregnancy were summarized and compared for women with complete remission of EC/AEH after fertility-sparing treatments. A subgroup analysis was performed based on whether patients had receivedin vitrofertilization and embryo transfer (IVF-ET) treatment. The complete remission and recurrence rates of EC/AEH following fertility-sparing treatments were estimated. The effect of pregnancy on recurrence rates of EC/AEH was also calculated.ResultsSixteen observational studies reporting pregnancy outcomes or recurrence with ART or spontaneous pregnancy for women with EC/AEH after fertility-sparing treatments were included. The complete remission rate of EC/AEH was 81.5% (95%CI, 78%–85%). Compared with spontaneous pregnancy, the pregnancy rate of ART was significantly higher (66.8% vs. 43.7%, OR ​= ​2.64, 95%CI 1.71–4.05,P<0.00001,I2 ​= ​14%). Subgroup analysis showed that the pregnancy rate of IVF-ET was significantly higher than that of spontaneous pregnancy (62.7% vs. 35.1%, OR ​= ​2.85, 95%CI 1.44-5.63,P ​= ​0.003,I2 ​= ​29%). The live birth rate of ART was significantly higher than that of spontaneous pregnancy (75.3% vs. 47.8%, OR ​= ​3.96, 95%CI1.76-8.77,P ​= ​0.0009,I2 ​= ​45%). The recurrence rate of EC/AEH was 31% (95%CI 24%–39%). Clinical pregnancy could reduce the recurrence rate of EC/AEH, but there was no significant evidence of an association.ConclusionsART, especially IVF-ET, could significantly improve pregnancy outcomes in women with EC/AEH receiving fertility-sparing treatments. Following complete remission, ART treatment might be a better option for women with EC/AEH than spontaneous pregnancy.

Objective: The purpose of this study was to analyze the benefits of gonadotropin-releasing hormone agonist (GnRHa) in premenopausal women undergoing hematopoietic cell transplantation(HSCT). Methods: Candidates for myeloablative chemotherapy HSCT requiring fertility preservation in the Gynecological Endocrinology Clinic of Peking University People's Hospital from December 2011 to December 2021 were retrospectively analyzed. The patients were consecutively included. Patients who chose to receive GnRHa treatment were given at least 2 courses of 3.75-mg dose of GnRHa treatment before myeloablative chemotherapy, and patients who chose not to receive GnRHa treatment were included in the control group. All patients were monitored for menstruation return, menopause-related symptoms, and ovarian function tests (follicle-stimulating hormone (FSH), luteinizing hormone (LH), and estradiol) were done 6-12 months after HSCT. In addition, we counted the vaginal bleeding of patients in the laminar air-flow room (LAFR). Results: A total of 234 cases were included in this study, 77 cases in the treatment group and 157 cases in the control group. Compared with the control group, the incidence of vaginal bleeding in LAFR in the treatment group was significantly lower than that in the control group (24.68% vs. 79.62%, P<0.001). The menopausal symptoms of the patients in the treatment group were reduced after transplantation (46.75% vs. 19.75%, P<0.001). There was no difference in visible follicles by the follow-up ultrasound in the two groups after HSCT (16.88% vs. 13.38%, P=0.474). The level of FSH at 6-12 months after transplantation was lower (98.00 mIU/ml vs. 117.53 mIU/ml, P=0.001). The proportion of patients with FSH <40 mIU/ml did not differ between the two groups. One patient in the treatment group recovered spontaneous menstruation while none in the control group (1.30% vs. 0%, P=0.329). Conclusion: The use of GnRHa may relieve menopause-related symptoms, reduce vaginal bleeding in LAFR and breakthrough bleeding after transplantation. GnRHa treatment can reduce the level of FSH after myeloablative chemotherapy, but it cannot reduce the incidence of premature ovarian failure in women of reproductive age following myeloablative HSCT.