Hysteroscopic Endometrial Resection and Insertion of Levonorgestrel Intrauterine Device (LNG-IUD) as a Fertility Preserving Procedure in Young Females with Atypical Endometrial Hyperplasia.

Background: The conservative management of atypical endometrial hyperplasia (AEH) using different management strategies will be important in females who want to conceive. However, complete data were lacking regarding selection criteria of the patients, optimal therapeutic strategies, and follow-up periods. The aim of this study was to evaluate feasibility, safety, effectiveness, fertility, and long-term outcomes of hysteroscopic endometrial resection in combination with Levonorgestrel Intrauterine Device (LNG-IUD) as fertility-sparing strategies of management of premenopausal young females with AEH. Methods: We prospectively evaluated clinical files of 35 patients with AEH who underwent hysteroscopic resection of the lesion with insertion of LNG-IUD. LNG-IUD maintenance in its site was made for 12 months then removal of it was made for women with complete response (CR) then they were allowed to conceive naturally. Patients with recurrent, progressive, or resistant disease will undergo definitive surgical management by total hysterectomy and bilateral salpingoophorectomy. Results: We found that about 31 (88.5%) patients achieved and maintained a CR and LNG-IUD removed. 20 out of the 31 patients (64.5%) who had removed LNG-IUD became pregnant after natural conception in the following twelve months. 13 (65%) babies were born by Caesarean section at 39 weeks of gestation, and seven (35%) were born at term spontaneously. We found no recurrence in the 24 months of followup. Conclusions: We showed that combination of hysteroscopic superficial endometrial resection followed by insertion of LNG-IUD was considered safe and effective management procedure for young females with AEH who desired to preserve their fertility due to negligible progression and recurrence rates with accepted pregnancy and life births rates. [ABSTRACT FROM AUTHOR]