# Oncologic and Reproductive Outcomes of Fertility-Sparing Management in Early-Stage Endometrial Carcinoma: A Systematic Review and Meta-Analysis

## TL;DR

This study reviews fertility-sparing treatments for early-stage endometrial cancer, finding they offer good initial remission but with notable recurrence rates and moderate chances of successful pregnancy.

## Contribution

The study provides a comprehensive meta-analysis of oncologic and reproductive outcomes of fertility-sparing treatments for early-stage endometrial cancer.

## Key findings

- Fertility-sparing treatments achieved a 74% complete remission rate, but 35% of these patients experienced cancer recurrence.
- Combination strategies with hysteroscopic resection showed higher remission durability and lower recurrence compared to hormonal monotherapy.
- Approximately 48% of women achieved pregnancy and 36% had live births after treatment.

## Abstract

Early-stage endometrial cancer is increasingly diagnosed in young women who wish to preserve their fertility, even though standard treatment involves removal of the uterus. Conservative, fertility-sparing treatments using hormonal therapy or minimally invasive surgery have therefore been developed, but their long-term effectiveness and reproductive success remain uncertain. We reviewed and analyzed data from 76 studies including more than 2500 women with early-stage endometrial cancer treated conservatively. Overall, approximately 70–75% of women achieved an initial remission with fertility-sparing treatment, although cancer recurrence occurred in about 30–35% of those who responded. Strategies combining hormonal therapy with hysteroscopic removal of visible disease were associated with higher remission durability and lower rates of early treatment failure compared with hormonal treatment alone. Following remission, conception occurred in approximately 45–50% of women attempting pregnancy, while 35–40% resulted in live births. Together, these findings illustrate both the potential benefits and the inherent limitations of fertility-sparing treatment and may help support realistic counseling and individualized clinical decision-making.

Background/Objectives: Fertility-sparing treatment is an accepted option for selected women with early-stage endometrial carcinoma, yet comparative evidence on oncologic durability and reproductive success remains limited. This systematic review and meta-analysis aimed to evaluate oncologic and reproductive outcomes across available fertility-preserving strategies in early-stage endometrial carcinoma. Methods: A systematic search of MEDLINE, Embase, Web of Science, CENTRAL, and Scopus was conducted from inception to 13 April 2025. Eligible studies included women of reproductive age with FIGO stage IA endometrial carcinoma undergoing fertility-sparing treatment. Studies enrolling mixed populations were included only if carcinoma-specific outcomes could be clearly identified; cases of atypical endometrial hyperplasia or endometrial intraepithelial neoplasia were not included in the quantitative synthesis. Outcomes included the rates of complete response, recurrence, partial response, no response, pregnancy, and live birth. Meta-analyses with random-effect models were performed, with subgroup analyses by treatment strategy. Risk of bias was assessed using ROBINS-I and RoB 2 tools. The review was preregistered in PROSPERO. Meta-analyses were conducted using R software, v4.4.2 (R Foundation for Statistical Computing, Vienna, Austria). Results: Seventy-six studies involving 2507 women were included. The pooled complete response rate was 74% (95% CI: 69–79%), while recurrence occurred in 35% (95% CI: 28–42%) of complete responders. Strategies incorporating hysteroscopic resection, alongside other combination regimens, consistently demonstrated higher complete response rates (85%) and lower recurrence (14–16%) compared with oral progestin or LNG-IUD monotherapy. Early treatment failure, with pooled partial and no response rates of 6% and 16%, respectively, particularly affecting monotherapy regimens. The pooled pregnancy and live birth rates were 48% (95% CI: 41–54%) and 36% (95% CI: 29–43%), with more consistent reproductive outcomes observed with combination strategies. Conclusions: Fertility-sparing treatment in early-stage endometrial carcinoma is associated with high initial remission rates; however, the durability of response remains limited, while overall reproductive success is moderate. Accumulating evidence suggests that combination strategies, particularly those incorporating hysteroscopic resection, are associated with more favorable oncologic control and reproductive outcomes compared with hormonal monotherapy. Accordingly, fertility preservation should be regarded as a carefully selected, time-limited approach that requires close surveillance and individualized patient counseling.