Objectives Endometrial adenocarcinoma affects over 380,000 women annually, with increasing incidence primarily driven by obesity. 5–7% of women are below 45 years at diagnosis, and many of these desire fertility-preservation rather than standard surgical treatment. This updated review aims to inform decision making in clinical practice, by evaluating the efficacies of different fertility-preserving treatments on the live birth, regression and relapse rates for women with endometrial carcinoma desiring fertility.

Methods A systematic search was performed of Medline, Embase, Central, & Cochrane, to identify studies describing fertility-preserving treatment for endometrial cancer. Patients were divided into 3 treatment groups: systemic progestogens, intra-uterine progestogens, or hysteroscopic resection with adjuvant progestogen. A random-effects meta-analysis model was used.

Results 41 observational studies met inclusion criteria, with 1057 patients in total. The proportion of women receiving systemic progestogens who achieved a live birth was 18.1% (95% CI 12.6–23.7%), remission 71.5% (95% CI 66.5–76.4%) and relapse 20.3% (95% CI 13.1–27.4%). For intra-uterine progestogens, the proportion achieving a live birth was 13.3% (95% CI 11.1–15.5%), remission 65.9% (95% CI 53.0–78.8%) and relapse 2.86% (95% CI 0.0–9.16%). For hysteroscopic resection, the proportion achieving a live birth was 19.1% (95% CI 8.79–29.5%), remission 82.7% (95% CI 73.1–92.3%) and relapse 6.80% (95% CI 1.72–11.9%).

Conclusions Although the quality of evidence is limited, these results demonstrate that hysteroscopic resection with adjuvant progestogen is associated with the highest rates of live birth and remission. This enables women considering such treatments to be fully counselled on the realistic possibilities of their desired reproductive and oncological outcomes.