PDF icon PDF herunterladen
Semin Reprod Med
DOI: 10.1055/s-0045-1809532
Review Article

Fertility Challenges Facing Women with Early-Stage Endometrial Cancer

Kirsten Tryde Macklon 
1   Department of Gynecology, Fertility and Obstetrics, Copenhagen University Hospital, Rigshospitalet, Denmark
› Institutsangaben
› Weitere Informationen
  Lizenzen und Reprints
Preview

Abstract

Young women diagnosed with endometrial cancer may have a fertility wish and may, under certain conditions, be offered fertility-sparing treatment. However, they may also have underlying infertility issues, as anovulation, obesity, polycystic ovary syndrome, and advanced maternal age are often found in women with endometrial cancer or atypical hyperplasia. These fertility issues may hinder pregnancy or prolong the time to pregnancy, in a situation where not much time is allowed to try for a pregnancy. Referral to a reproductive specialist is recommended as early as possible to detect any possible underlying infertility issues that might require assisted reproductive technology once a pregnancy is allowed or may even contradict fertility-sparing treatment. Ovarian reserve testing is a tool used to assess a woman's ovarian reserve, although it cannot, as such, be used to predict the chance of pregnancy. In case of obesity, weight loss is recommended as soon as possible.

Keywords

endometrial cancer - fertility - obesity - ovarian reserve - PCOS


Publikationsverlauf

Artikel online veröffentlicht:
06. Juni 2025

© 2025. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Rodolakis A, Scambia G, Planchamp F. et al. ESGO/ESHRE/ESGE Guidelines for the fertility-sparing treatment of patients with endometrial carcinoma. Hum Reprod Open 2023; 2023 (01) hoac057
    PubMedSuche in Google Scholar
  • 2 Nordcan 2.0. Accessed October 30, 2024 at: https://nordcan.iarc.fr/en/dataviz/trends?key=total&sexes=2&cancers=200&populations=0&age_end=8
    PubMed
  • 3 Reed SD, Newton KM, Clinton WL. et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009; 200 (06) 678.e1-678.e6
    PubMedSuche in Google Scholar
  • 4 Balen AH. Infertility in Practice. 4th ed. Boca Raton: CRC Press; 2014
    Suche in Google Scholar
  • 5 Younis JS, Iskander R, Fauser BCJM, Izhaki I. Does an association exist between menstrual cycle length within the normal range and ovarian reserve biomarkers during the reproductive years? A systematic review and meta-analysis. Hum Reprod Update 2020; 26 (06) 904-928
    PubMedSuche in Google Scholar
  • 6 Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org, Practice Committee of the American Society for Reproductive Medicine. Testing and interpreting measures of ovarian reserve: a committee opinion. Fertil Steril 2020; 114 (06) 1151-1157
    CrossrefPubMedSuche in Google Scholar
  • 7 Nelson SM, Iliodromiti S, Fleming R, Anderson R, McConnachie A, Messow CM. Reference range for the antimüllerian hormone Generation II assay: a population study of 10,984 women, with comparison to the established Diagnostics Systems Laboratory nomogram. Fertil Steril 2014; 101 (02) 523-529
    PubMedSuche in Google Scholar
  • 8 Ferraretti AP, La Marca A, Fauser BCJM, Tarlatzis B, Nargund G, Gianaroli L. ESHRE working group on Poor Ovarian Response Definition. ESHRE consensus on the definition of ‘poor response’ to ovarian stimulation for in vitro fertilization: the Bologna criteria. Hum Reprod 2011; 26 (07) 1616-1624
    CrossrefPubMedSuche in Google Scholar
  • 9 Esteves SC, Alviggi C, Humaidan P. et al. The POSEIDON criteria and its measure of success through the eyes of clinicians and embryologists. Front Endocrinol (Lausanne) 2019; 10: 814
    PubMedSuche in Google Scholar
  • 10 Peigné M, Bernard V, Dijols L. et al. Using serum anti-Müllerian hormone levels to predict the chance of live birth after spontaneous or assisted conception: a systematic review and meta-analysis. Hum Reprod 2023; 38 (09) 1789-1806
    PubMedSuche in Google Scholar
  • 11 Tal R, Tal O, Seifer BJ, Seifer DB. Antimüllerian hormone as predictor of implantation and clinical pregnancy after assisted conception: a systematic review and meta-analysis. Fertil Steril 2015; 103 (01) 119-30.e3
    PubMedSuche in Google Scholar
  • 12 Yuwen T, Yang Z, Cai G, Feng G, Liu Q, Fu H. Association between serum AMH levels and IVF/ICSI outcomes in patients with polycystic ovary syndrome: a systematic review and meta-analysis. Reprod Biol Endocrinol 2023; 21 (01) 95
    PubMedSuche in Google Scholar
  • 13 Hvidman HW, Bentzen JG, Thuesen LL. et al. Infertile women below the age of 40 have similar anti-Müllerian hormone levels and antral follicle count compared with women of the same age with no history of infertility. Hum Reprod 2016; 31 (05) 1034-1045
    PubMedSuche in Google Scholar
  • 14 Galati G, Reschini M, Chiné' A. et al. Ovarian reserve does not influence natural conception: insights from infertile women. Arch Gynecol Obstet 2024; 310 (05) 2691-2696
    PubMedSuche in Google Scholar
  • 15 Tufan E, Elter K, Durmusoglu F. Assessment of reproductive ageing patterns by hormonal and ultrasonographic ovarian reserve tests. Hum Reprod 2004; 19 (11) 2484-2489
    PubMedSuche in Google Scholar
  • 16 La Marca A, Spada E, Sighinolfi G. et al. Age-specific nomogram for the decline in antral follicle count throughout the reproductive period. Fertil Steril 2011; 95 (02) 684-688
    CrossrefPubMedSuche in Google Scholar
  • 17 Bentzen JG, Forman JL, Johannsen TH, Pinborg A, Larsen EC, Andersen AN. Ovarian antral follicle subclasses and anti-mullerian hormone during normal reproductive aging. J Clin Endocrinol Metab 2013; 98 (04) 1602-1611
    CrossrefPubMedSuche in Google Scholar
  • 18 Bentzen JG, Forman JL, Pinborg A. et al. Ovarian reserve parameters: a comparison between users and non-users of hormonal contraception. Reprod Biomed Online 2012; 25 (06) 612-619
    PubMedSuche in Google Scholar
  • 19 Broer SL, Dólleman M, Opmeer BC, Fauser BC, Mol BW, Broekmans FJ. AMH and AFC as predictors of excessive response in controlled ovarian hyperstimulation: a meta-analysis. Hum Reprod Update 2011; 17 (01) 46-54
    PubMedSuche in Google Scholar
  • 20 La Marca A, Sunkara SK. Individualization of controlled ovarian stimulation in IVF using ovarian reserve markers: from theory to practice. Hum Reprod Update 2014; 20 (01) 124-140
    CrossrefPubMedSuche in Google Scholar
  • 21 Hendriks DJ, Mol BWJ, Bancsi LFJMM, Te Velde ER, Broekmans FJ. Antral follicle count in the prediction of poor ovarian response and pregnancy after in vitro fertilization: a meta-analysis and comparison with basal follicle-stimulating hormone level. Fertil Steril 2005; 83 (02) 291-301
    PubMedSuche in Google Scholar
  • 22 Franasiak JM, Forman EJ, Hong KH. et al. The nature of aneuploidy with increasing age of the female partner: a review of 15,169 consecutive trophectoderm biopsies evaluated with comprehensive chromosomal screening. Fertil Steril 2014; 101 (03) 656-663.e1
    CrossrefPubMedSuche in Google Scholar
  • 23 Broekmans FJ, Soules MR, Fauser BC. Ovarian aging: mechanisms and clinical consequences. Endocr Rev 2009; 30 (05) 465-493
    CrossrefPubMedSuche in Google Scholar
  • 24 Chua SJ, Danhof NA, Mochtar MH. et al. Age-related natural fertility outcomes in women over 35 years: a systematic review and individual participant data meta-analysis. Hum Reprod 2020; 35 (08) 1808-1820
    PubMedSuche in Google Scholar
  • 25 Vitagliano A, Paffoni A, Viganò P. Does maternal age affect assisted reproduction technology success rates after euploid embryo transfer? A systematic review and meta-analysis. Fertil Steril 2023; 120 (02) 251-265
    PubMedSuche in Google Scholar
  • 26 Reig A, Franasiak J, Scott Jr RT, Seli E. The impact of age beyond ploidy: outcome data from 8175 euploid single embryo transfers. J Assist Reprod Genet 2020; 37 (03) 595-602
    PubMedSuche in Google Scholar
  • 27 Zhao J, Huang B, Li N, Wang X, Xu B, Li Y. Relationship between advanced maternal age and decline of endometrial receptivity: a systematic review and meta-analysis. Aging (Albany NY) 2023; 15 (07) 2460-2472
    PubMedSuche in Google Scholar
  • 28 Segal TR, Kim K, Mumford SL, Goldfarb JM, Weinerman RS. How much does the uterus matter? Perinatal outcomes are improved when donor oocyte embryos are transferred to gestational carriers compared to intended parent recipients. Fertil Steril 2018; 110 (05) 888-895
    PubMedSuche in Google Scholar
  • 29 NCD Risk Factor Collaboration (NCD-RisC). Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet 2017; 390 (10113): 2627-2642
    CrossrefPubMedSuche in Google Scholar
  • 30 Moslehi N, Shab-Bidar S, Ramezani Tehrani F, Mirmiran P, Azizi F. Is ovarian reserve associated with body mass index and obesity in reproductive aged women? A meta-analysis. Menopause 2018; 25 (09) 1046-1055
    PubMedSuche in Google Scholar
  • 31 Zhou J, Zhang Y, Teng Y. et al. Association between preconception body mass index and fertility in adult female: A systematic review and meta-analysis. Obes Rev 2024; 25 (10) e13804
    PubMedSuche in Google Scholar
  • 32 Turner F, Powell SG, Al-Lamee H. et al. Impact of BMI on fertility in an otherwise healthy population: a systematic review and meta-analysis. BMJ Open 2024; 14 (10) e082123
    PubMedSuche in Google Scholar
  • 33 Supramaniam PR, Mittal M, McVeigh E, Lim LN. The correlation between raised body mass index and assisted reproductive treatment outcomes: a systematic review and meta-analysis of the evidence. Reprod Health 2018; 15 (01) 34
    PubMedSuche in Google Scholar
  • 34 Sermondade N, Huberlant S, Bourhis-Lefebvre V. et al. Female obesity is negatively associated with live birth rate following IVF: a systematic review and meta-analysis. Hum Reprod Update 2019; 25 (04) 439-451
    CrossrefPubMedSuche in Google Scholar
  • 35 Einarsson S, Bergh C, Friberg B. et al. Weight reduction intervention for obese infertile women prior to IVF: a randomized controlled trial. Hum Reprod 2017; 32 (08) 1621-1630
    CrossrefPubMedSuche in Google Scholar
  • 36 Boyle BR, Ablett AD, Ochi C. et al. The effect of weight loss interventions for obesity on fertility and pregnancy outcomes: a systematic review and meta-analysis. Int J Gynaecol Obstet 2023; 161 (02) 335-342
    PubMedSuche in Google Scholar
  • 37 Jeong HG, Cho S, Ryu KJ, Kim T, Park H. Effect of weight loss before in vitro fertilization in women with obesity or overweight and infertility: a systematic review and meta-analysis. Sci Rep 2024; 14 (01) 6153
    PubMedSuche in Google Scholar
  • 38 Boedt T, Vanhove AC, Vercoe MA, Matthys C, Dancet E, Lie Fong S. Preconception lifestyle advice for people with infertility. Cochrane Database Syst Rev 2021; 4 (04) CD008189
    PubMedSuche in Google Scholar
  • 39 Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). Hum Reprod 2004; 19 (01) 41-47
    CrossrefPubMedSuche in Google Scholar
  • 40 Teede HJ, Misso ML, Costello MF. et al; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110 (03) 364-379
    CrossrefPubMedSuche in Google Scholar
  • 41 Hoeger KM, Dokras A, Piltonen T. Update on PCOS: consequences, challenges, and guiding treatment. J Clin Endocrinol Metab 2021; 106 (03) e1071-e1083
    CrossrefPubMedSuche in Google Scholar
  • 42 Hudecova M, Holte J, Olovsson M, Sundström Poromaa I. Long-term follow-up of patients with polycystic ovary syndrome: reproductive outcome and ovarian reserve. Hum Reprod 2009; 24 (05) 1176-1183
    PubMedSuche in Google Scholar
  • 43 Cooney LG, Dokras A. Beyond fertility: polycystic ovary syndrome and long-term health. Fertil Steril 2018; 110 (05) 794-809
    CrossrefPubMedSuche in Google Scholar
  • 44 Fearnley EJ, Marquart L, Spurdle AB, Weinstein P, Webb PM. Australian Ovarian Cancer Study Group and Australian National Endometrial Cancer Study Group. Polycystic ovary syndrome increases the risk of endometrial cancer in women aged less than 50 years: an Australian case-control study. Cancer Causes Control 2010; 21 (12) 2303-2308
    CrossrefPubMedSuche in Google Scholar
  • 45 Palomba S, Piltonen TT, Giudice LC. Endometrial function in women with polycystic ovary syndrome: a comprehensive review. Hum Reprod Update 2021; 27 (03) 584-618
    PubMedSuche in Google Scholar
  • 46 Morley LC, Tang T, Yasmin E, Norman RJ, Balen AH. Insulin-sensitising drugs (metformin, rosiglitazone, pioglitazone, D-chiro-inositol) for women with polycystic ovary syndrome, oligo amenorrhoea and subfertility. Cochrane Database Syst Rev 2017; 11 (11) CD003053
    PubMedSuche in Google Scholar
  • 47 Magzoub R, Kheirelseid EAH, Perks C, Lewis S. Does metformin improve reproduction outcomes for non-obese, infertile women with polycystic ovary syndrome? Meta-analysis and systematic review. Eur J Obstet Gynecol Reprod Biol 2022; 271: 38-62
    PubMedSuche in Google Scholar
  • 48 Shiwani H, Clement NS, Daniels JP, Atiomo W. Metformin for endometrial hyperplasia. Cochrane Database Syst Rev 2024; 5 (05) CD012214
    PubMedSuche in Google Scholar
  • 49 Dallagiovanna C, Filippi F, Riccaboni A. et al. The neglected role of preimplantation genetic testing for Lynch syndrome. Reprod Biomed Online 2023; 46 (03) 421-423
    PubMedSuche in Google Scholar