Fertility preservation and oncological outcomes: A retrospective observational pilot study at a university health institution

Introduction/Objective. Atypical endometrial hyperplasia (AEH) and endometrial intraepithelial neoplasia (EIN) are precursor lesions of endometrioid adenocarcinoma, often detected at an early stage in reproductive-aged women, where fertility-sparing treatment (FST) is crucial. This study aimed to evaluate diagnostic methods, treatment strategies, and outcomes of FST approaches in Novi Sad, Serbia. Methods. This retrospective observational pilot study evaluated reproductive-aged patients with AEH or FIGO IA1 EIN treated at the University Clinical Center of Vojvodina. Results. A total of 21 reproductive-aged patients (mean age 37.2 ? 4.31 years) were analyzed, with AEH being the most common diagnosis in 14 (67%) patients. Most patients, 19 (90%), were referred for oncofertility consultation (p < 0.001), and 17 patients (81%) were recommended fertility-preserving treatments. The Mirena (Bayer AG, Leverkusen, Germany) levonorgestrel-releasing intrauterine system was the most common treatment modality in 14 (67%) patients (p < 0.001), especially among those planning future pregnancies, 11 (100%) (p < 0.05). Psychological counseling was considered important by 14 patients (67%). Seven patients (33%) achieved pregnancy post-treatment, all resulting in live births, with four spontaneous and three in vitro fertilization pregnancies. Younger patients were more likely to plan future pregnancies (mean age 34.2 vs. 40 years, p < 0.001) and to achieve pregnancy post-treatment (mean age 33.6 vs. 39.1 years, p < 0.001). Conclusion. Our study confirmed that fertility-preserving treatment for endometrial lesions is effective, aligns with guidelines, and addresses the shift toward younger patients, highlighting the need for uniform protocols and a unified registry.