Comparative Analysis of Progestin Intervention for Non-Atypical Endometrial Hyperplasia in Infertile Females with Anovulation: A Retrospective Study.

OBJECTIVE

To compare the efficacy of progestin intervention for non-atypical endometrial hyperplasia (non-atypical EH) in infertile patients with ovulatory dysfunction, and to explore factors associated with histological regression.

METHODS

A retrospective cohort study was conducted at a tertiary reproductive medicine center. A total of 171 infertile females with anovulation diagnosed with non-atypical EH by hysteroscopic biopsy between March 2021 and August 2024 were enrolled. Patients were divided into polycystic ovary syndrome (PCOS) group (n=89) and diminished ovarian reserve (DOR) group (n=82) according to ovarian reserve function. All patients received 3-month oral progestin therapy. The study aims to analyze and compare the regression of endometrial hyperplasia after 3 months of treatment. Multivariate logistic regression was used to analyze independent factors affecting treatment response.

RESULTS

After progestin treatment, the overall EH regression rate was 82.46%, with no significant difference between the DOR group (84.15%) and PCOS group (80.90%) (P=0.577). In the DOR subgroup, high-potency progestins achieved a significantly higher regression rate than dydrogesterone (89.83% vs 69.57%, P=0.040), while no such difference was found in the PCOS group (P=0.527). The clinical pregnancy rate (31.71% vs 48.31%, P=0.027) and live birth rate (14.63% vs 38.20%, P<0.001) were significantly lower in the DOR group. But no significant association was observed between progestin type and clinical pregnancy (P = 0.097, OR = 0.586, 95% CI 0.312-1.101).Multivariate analysis revealed that lower body mass index (BMI) (OR=0.893, 95% CI: 0.809-0.985, P=0.024) and high-potency progestin regimen (OR=2.913, 95% CI: 1.147-7.400, P=0.025) were independent protective factors for EH regression.

CONCLUSION

Progestin provides comparable histological regression for non-atypical EH in infertile females with anovulation. A potential benefit of high-potency progestins was observed among patients with DOR.