Impact of obesity on the results of fertility-sparing management for atypical hyperplasia and grade 1 endometrial cancer

• We studied the impact of obesity oncologic and reproductive outcomes in women treated conservatively for atypical hyperplasia and endometrial carcinoma.
• Similar response and recurrence rates we observed in obese and non obese patients.
• Pregnancy rate was higher in non obese patients in comparison with obese patients.

ObjectivesThe aim of the present study was to evaluate the impact of obesity on reproductive and oncologic outcomes on the success of fertility-sparing management.MethodsThis retrospective multicenter cohort study included women treated conservatively for atypical hyperplasia (AH) and endometrial cancer (EC) to preserve fertility. Five inclusion criteria were defined: (i) the presence of AH or grade 1 EC confirmed by two pathologists; (ii) adequate radiological examination before conservative management; (iii) available body mass index (BMI) at the beginning of treatment; and (iv) a minimum follow-up time of six months.ResultsForty patients fulfilled the inclusion criteria (17 had EC, and 23 had AH), mean age and BMI were 33 years and 29 kg/m2 respectively. Among the 15 obese patients, after medical treatment, 10 patients responded (67%) and three relapsed, whereas in the 25 non-obese patients, 19 responded (76%) and three relapsed (p = 0.72). The overall pregnancy rate and follow-up time were 35% and 35 months respectively. Among the 15 obese patients, after medical treatment, two patients became pregnant, whereas in the 25 non-obese patients, 12 became pregnant (p = 0.04).ConclusionDespite similar response and recurrence rates, our results suggest that fertility-sparing management for AH and EC is associated with a lower probability of pregnancy in obese patients.