Fertility Outcomes in Patients with Non-Surgical Management of Early-Stage Endometrial Cancer

Early-stage endometrial cancer (EC), traditionally managed via surgical intervention, presents a clinical dilemma in women desiring fertility preservation.With the growing incidence of EC among younger women and delays in childbearing, non-surgical management has gained traction as a viable alternative.This review explores fertility outcomes in patients undergoing conservative, non-surgical treatment for early-stage endometrial cancer, focusing on hormonal therapy strategies, assisted reproductive techniques, and long-term reproductive prognosis.Progestin-based regimens-primarily oral medroxyprogesterone acetate (MPA), megestrol acetate (MA), and levonorgestrel-releasing intrauterine devices (LNG-IUDs)-have demonstrated efficacy in achieving complete remission while preserving the uterus.These regimens are often augmented with lifestyle modifications and, in select cases, metformin to address coexisting metabolic syndrome or polycystic ovarian syndrome (PCOS).Fertility-sparing treatment is primarily considered for welldifferentiated (Grade 1), endometrioid-type cancers confined to the endometrium, confirmed via imaging and histology.Reported remission rates range from 65% to 85%, with recurrence in up to 30% of cases.Importantly, successful pregnancy outcomes are observed in a significant subset of patients, either through natural conception or assisted reproductive technologies (ART).However, delayed conception and recurrence risk necessitate close monitoring and multidisciplinary coordination among oncologists, reproductive endocrinologists, and maternal-fetal medicine specialists.This paper highlights the prognostic factors influencing reproductive success, including age, BMI, histologic response, and the time to remission.It also discusses the ethical considerations, counseling strategies, and emerging therapies that may improve reproductive outcomes.In conclusion, non-surgical management offers hope for fertility preservation in select EC patients, though individualized risk-benefit assessment and long-term surveillance remain critical components of care.