Analysis of pregnancy outcome in women with endometrial atypical hyperplasia after conservative treatment

Objective To determine the pregnancy outcome in women with endometrial atypical hyperplasia after conservative treatment.Methods From March 1,2009 to August 31,2012,four patients with endometrial atypical hyperplasia who had received satisfactory conservative therapy were treated in the Center of Reproduction and Genetics,Peking University First Hospital.All patients achieved clinical intrauterine pregnancies.One patient became pregnant twice.We reviewed the data of five pregnancies in these four patients.The data for each patient were recorded,including endometrium pathology diagnoses before pregnancy,fertilitysparing approaches,assisted reproductive technologies for conceiving,pregnancy complications,termination time of their pregnancies,the delivery mode and the postpartum status.Results All the patients underwent dilatation and curettage.The endometrium pathology diagnoses in each patient were complex mild-moderate atypical hyperplasia,complex moderate atypical hyperplasia,complex atypical hyperplasia and extensive atypical hyperplasia with endometrial intraepithelial neoplasia (EIN),respectively.Cases 1,2 and 3 received medroxyprogesterone acetate 250 mg/d for eleven,eight and four months,respectively.Case 4 received megestrol acetate 160 mg/d for eight months.Endometrial atypical hyperplasia was not found by dilatation and curettage after treatment.Case 1 achieved a singleton pregnancy following follicle stimulating hormone-induced ovulation three months after drug withdrawal.Case 2 and 4 achicvcd a singleton pregnancy by inspection ovulation the month after drug withdrawal.The first pregnancy in Case 2 resulted in embryo diapause at nine weeks of gestation,and the second singleton pregnancy by inspection ovulation occurred six months after curettage.Case 3 failed to conceive following clomiphene citrate-induced ovulation for two months.The patient underwent repeat dilatation and curettage due to abnormal uterine bleeding and was diagnosed with EIN.She was retreated with megestrol acetate 160 mg/d for eight months.The patient then received in vitro fertilization and embryo transfer and achieved a twin pregnancy,but aborted at 22+6 weeks.Case 1,2 (the second pregnancy) and 4 achieved full-term pregnancy.In five pregnancies,one case underwent embryo diapause in early pregnancy,one case underwent late pregnancy abortion,and three cases achieved full term pregnancies and three healthy infants.Conclusions Patients with endometrial atypical hyperplasia who receive conservative treatment can conceive successfully and have an optimistic pregnancy outcome after appropriate assisted reproductive technology.However,complications,such as abortion,are more common in these patients.Close monitoring is required during pregnancy to determine abnormal conditions and administer appropriate and timely treatment. Key words: Endometrial hyperplasia;  Drug therapy;  Pregnancy outcome