Fertility preservation with successful pregnancy outcome in a young patient with endometrial cancer

The rising incidence of endometrial cancer (EC) in young women presents a significant challenge in balancing oncologic safety with fertility preservation. While fertility-sparing treatment is an option for carefully selected patients with early-stage, well-differentiated EC, management of recurrence and optimization of fertility outcomes remain complex.

A 33-year-old nulliparous woman was diagnosed with Grade 1 endometrioid adenocarcinoma confined to the endometrium (ER/PR positive). After multidisciplinary team (MDT) evaluation confirmed eligibility, she received first-line high-dose progestin therapy. Complete remission (CR) was achieved and confirmed by hysteroscopy at 3 months, followed by 3 months of consolidation therapy. During preparation for embryo transfer after successful oocyte retrieval via a progestin-primed ovarian stimulation (PPOS) protocol, recurrence was detected hysteroscopically. Retreatment with the same progestin regimen led to a second CR after 6 months. Subsequently, a thawed embryo transfer resulted in a successful pregnancy, culminating in the delivery of a healthy infant at term.

This case suggests that successful fertility preservation and live birth may be achievable in young patients with early-stage EC when a structured approach is applied-including strict MDT selection, standardized progestin therapy with diligent surveillance, proactive management of recurrence, and well-timed assisted reproductive technology (ART). Notably, repeat conservative treatment for localized recurrence was successfully employed in this patient. Integrating weight management and comprehensive molecular profiling into future treatment paradigms could further optimize outcomes, but these observations require validation in larger cohorts.