title: Impact of obesity on the results of fertility-sparing management for atypical hyperplasia and grade 1 endometrial cancer.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the impact of obesity on reproductive and oncologic outcomes on the success of fertility-sparing management.
  
  
  METHODS
  This 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.
  
  
  RESULTS
  Forty patients fulfilled the inclusion criteria (17 had EC, and 23 had AH), mean age and BMI were 33 years and 29kg/m(2) 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).
  
  
  CONCLUSIONS
  Despite 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.
authors.affiliation: Department of Obstetrics and Gynecology, APHP Hôpital Bichat, Paris, France.
authors.forename: Clémentine
authors.initials: C
authors.lastname: Gonthier
authors.affiliation: Department of Pathology, APHP Hôpital Bichat, Paris, France.
authors.forename: Francine
authors.initials: F
authors.lastname: Walker
authors.affiliation: Department of Obstetrics and Gynecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University Paris 07, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Luton
authors.affiliation: Department of Obstetrics and Gynecology, APHP Hôpital Bichat, Paris, France.
authors.forename: Chadi
authors.initials: C
authors.lastname: Yazbeck
authors.affiliation: Department of Obstetrics and Gynecology, APHP Hôpital Bichat, Paris, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Madelenat
authors.affiliation: Department of Obstetrics and Gynecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University Paris 07, France; UMR S 938, CdR St Antoine UPMC University Paris 06, France; EA 7285, UVSQ, Montigny-le-Bretonneux, France. Electronic address: martin.koskas@bch.aphp.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000628:therapy*; D000328:Adult; D015331:Cohort Studies; D004714:Endometrial Hyperplasia / Q000150:complications / Q000628:therapy*; D016889:Endometrial Neoplasms / Q000150:complications / Q000628:therapy*; D005260:Female; D059247:Fertility Preservation / Q000379:methods*; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006801:Humans; D015907:Hysteroscopy; D053208:Kaplan-Meier Estimate; D009765:Obesity / Q000150:complications*; D059351:Organ Sparing Treatments / Q000379:methods*; D011247:Pregnancy; D018873:Pregnancy Rate; D011372:Progestins / Q000627:therapeutic use*; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D011372:Progestins; D007987:Gonadotropin-Releasing Hormone
keywords: Endometrial adenocarcinoma; Endometrial atypical hyperplasia; Fertility-sparing management; Obesity