Introduction Endometrial Cancer (EC) is the commonest gynaecological cancer in Singapore and affects an increasing number of women desiring fertility. With increasing recognition that fertility-sparing options of treatment are feasible in carefully selected cases, our institution developed a protocol to manage such patients. We report the characteristics of this pilot cohort of patients and describe their oncological and fertility outcomes.

Methods Patients undergoing conservative treatment for EC and endometrial hyperplasia (EH) were identified from the gynaecologic oncology tumour group database. A total of 27 patients were identified between January 2015 to May 2022. Information was obtained from their electronic medical records.

Results The average age of the women was 37 years, of which almost all of them were overweight. Of the 27 women desiring fertility, 16 women had EC, and 11 women had EH. Regression to benign histology was noted in 100% in EH group, and 81% in EC, median time to regression to benign histology was 11.4 and 10 months respectively. 26% in EH group and 31% in EC group recurred within 33 and 8 months respectively. 2 women in EC group underwent IVF and 1 patient became pregnant spontaneously and subsequently had a live birth. One patient failed fertility-sparing treatment, was diagnosed with stage IIIC serous cancer, and underwent definitive surgical debulking and adjuvant systemic therapy.

Conclusion/Implications Fertility-sparing treatment appears to be a safe management option in women with EC or EH desiring fertility. Multi-disciplinary patient support improves patient compliance and treatment outcomes.