Can eggs be harvested before a hysterectomy in a young woman with early stage endometrial cancer?

Egg Harvesting Before Hysterectomy in Early-Stage Endometrial Cancer

Yes, eggs can and should be harvested before hysterectomy in carefully selected young women with early-stage endometrial cancer who desire future fertility, but only after comprehensive oncologic evaluation confirms eligibility for any fertility-preserving approach.

Patient Selection Criteria for Fertility Preservation Discussion

Before considering egg harvesting, the patient must meet strict oncologic criteria that would make her eligible for fertility-sparing treatment consideration:

• Age younger than 45 years with grade 1 endometrioid endometrial cancer (EEC) 1
• Myometrial invasion less than 50% confirmed by expert ultrasound, MRI, or intraoperative pathological examination 1
• No obvious ovarian or extra-uterine disease on imaging 1
• Stage IA disease only (tumor confined to endometrium or <50% myometrial invasion) 2, 3
• No family history of ovarian cancer risk (BRCA mutation, Lynch syndrome) - these patients should undergo genetic counseling and are NOT candidates for ovarian preservation 1

Mandatory Pre-Treatment Evaluation

Before any fertility preservation discussion, including egg harvesting:

• Pelvic MRI is mandatory to exclude myometrial invasion and assess for extra-uterine disease 4, 2
• Expert gynaecopathologist review must confirm grade 1 endometrioid histology and exclude higher-grade or non-endometrioid subtypes 4
• Referral to specialized centers is required for all fertility preservation cases 4
• Comprehensive counseling must inform the patient that fertility preservation is non-standard treatment with oncologic risks 4

Timing and Safety of Egg Harvesting

Egg harvesting should occur BEFORE initiating any cancer treatment (whether conservative progestin therapy or definitive surgery):

• Ovarian stimulation drugs used for egg retrieval appear safe and do not worsen prognosis in endometrial cancer patients 2
• The procedure allows for cryopreservation of oocytes before bilateral salpingo-oophorectomy, which is the standard surgical component 1
• This provides future fertility options even if the patient ultimately requires complete surgical staging with oophorectomy 3

Critical Oncologic Considerations

The decision to harvest eggs does NOT change the oncologic management algorithm - it simply preserves future fertility options:

• If the patient meets criteria for ovarian preservation (age <45, grade 1 EEC, <50% myometrial invasion, no family history), she may undergo hysterectomy with ovarian preservation AND have eggs harvested beforehand 1
• If the patient does NOT meet ovarian preservation criteria but still desires fertility, egg harvesting before bilateral salpingo-oophorectomy is the only option for future biological children 1
• Salpingectomy is recommended even when ovaries are preserved, so egg harvesting provides additional security 1

Special Warnings and Contraindications

Do not proceed with egg harvesting if:

• Lynch syndrome or BRCA mutation is present - these patients require bilateral salpingo-oophorectomy and should not preserve ovaries 1
• Synchronous ovarian malignancy cannot be excluded - extreme care must be taken as 7-29% of young endometrial cancer patients may have concurrent ovarian pathology 1, 5
• Non-endometrioid histology (serous, clear cell, carcinosarcoma) - these require aggressive surgical staging with bilateral salpingo-oophorectomy 1, 6
• Grade 2 or 3 disease - these are NOT candidates for ovarian preservation 1

Common Pitfalls to Avoid

• Do not delay definitive cancer treatment for prolonged fertility preservation attempts - egg harvesting can typically be completed within 2-3 weeks 2
• Do not assume ovarian preservation is safe without ruling out Lynch syndrome or BRCA mutations through genetic counseling 1
• Do not harvest eggs if synchronous ovarian cancer is suspected - two case reports document young women with endometrial cancer who developed ovarian cancer after ovarian preservation 5
• Do not proceed without MRI confirmation of disease confined to endometrium or <50% myometrial invasion 4, 2

Post-Harvest Management Options

After egg harvesting, the patient has two potential pathways:

1. Standard surgical treatment (hysterectomy ± bilateral salpingo-oophorectomy) with future use of harvested eggs via gestational carrier 1
2. Fertility-sparing progestin therapy (if she meets strict criteria) with attempt at pregnancy using her own uterus, followed by definitive hysterectomy after childbearing 4, 2, 3

After completion of childbearing, hysterectomy with bilateral salpingo-oophorectomy is strongly recommended to eliminate future cancer risk 4.