Live Birth Outcomes After Extended or Repeated High-Dose Medroxyprogesterone Acetate Therapy for Fertility-Sparing Management of Endometrial Neoplasia: A Single-Center Retrospective Case Series.

AIM: To clarify live birth outcomes among women receiving extended or repeated high-dose medroxyprogesterone acetate (MPA) therapy for fertility-sparing management of atypical endometrial hyperplasia or endometrioid carcinoma grade 1.

METHODS

We conducted a single-center retrospective case series of 53 patients undergoing MPA therapy between 2005 and 2023. Patients were stratified into three groups: (i) complete response (CR) within 6 months (standard group), (ii) CR after extended treatment beyond 6 months (extended group), and (iii) CR after MPA retreatment for first intrauterine recurrence (retreatment group). Primary outcome was the live birth rate (LBR). Secondary outcomes included the effect of initial reproductive intentions, interval from CR to conception, recurrence rates, and recurrence-free interval (RFI).

RESULTS

LBRs were 33% (10/30) in the standard group, 8% (1/12) in the extended group, and 17% (2/12) in the retreatment group. Among eight patients undergoing MPA retreatment for a second or subsequent recurrence, none achieved live birth. Patients with an initial desire for prompt conception had significantly higher LBRs than those without (38% vs. 5%, p < 0.01). Median time from CR to conception leading to live birth was 12 months. Patients achieving live birth had significantly longer RFIs than those without (p < 0.01).

CONCLUSIONS

Live birth is most likely when CR is achieved within 6 months of MPA therapy; nonetheless, extended or repeated MPA treatment may still result in live birth. These findings suggest the importance of appropriate patient selection and careful monitoring during extended or repeated therapy and attempting conception promptly in fertility-sparing management of endometrial neoplasia.