Introduction:

1. The effect of ART on gynecological cancer: Report of our experiences and literature reviewMojgankarimi -zarchi1*, Mitra rouhi2,Alime H. Abdolahi31-Corespondance:Associated professor, Gynecology Oncology fellowship, Gynecology Oncology Department, ShahidSadoughi University of Medical Science. Correspondence Address: Iran, 14194,Yazd, Safaieh, ShahidGhandiBlv. ShahidSadoughi Hospital, 2 flow, Surgical Oncology Department2,3Medical Student Scientific Association, Faculty of Medical Sciences, Islamic Azad University, Yazd Branch, Yazd, Iran.Phone number: #983518224000-9,Fax: #983518224100,Email:drkarimi2001@yahoo.com Introduction: Infertility is being as an important and common problem in couples that needs to assisted reproductive technology (ART) or the other drug therapy. Infertility has been known as a risk factor for ovarian cancer, breast cancer and endometrial cancer but there is a question about the relationship of these cancers to infertility itself or drugs and methods of infertility treatment. Material and method: We evaluated all of risk factors in patients with breast cancer, ovarian cancer and endometrial cancers who referred to Gynecological Oncology Clinic in Shahid Sadoughi Hospital within 2002-2012 .In a retrograde study, we investigated the history of primary infertility and ART before diagnosis of cancers in patients . Result: We registered 92 patients with endometrial cancer,84 patients with advanced epithelial ovarian cancer and 113 patients with breast cancer. There was infertility history in 39.1% of endometrial cancer who were obese (BMI>30)and 18.8% of patients with normal body mass index(BMI=25-29). ART was founded in 7.3% of all patients with endometrial cancer. Also in patients with epithelial ovarian cancer, female infertility has been diagnosed in 28.4% and ART in 14.1%.Clomiphen therapy with or without HCG and HMG was the most common drugs which was used for patients with ovarian cancer. In all patients with breast cancer,there was infertility in 16.5% and ART was diagnosed in 7.3%. Conclusion: Although infertility was diagnosed as an important and fairly common risk factor in endometrial,ovarian and breast cancer, but some other factors are more important. Age,body mass index and cause of infertility are also important. Finding the association of ART to gynecological cancers need some other long cohort studies which follow the infertile women who get the ART or drug therapy for over 15-20 years. The other studies in this field cannot answer to our question about increasing gynecological cancer due to ART. We think BMI and age are co-factors to cancers which should added to infertility or ART. We had better discus this relationship to the partners and have a multidisciplinary management for obese infertile women who had had polycystic ovarian syndrome or age more than 35 years. Breast cancer screening should be investigate in infertile women after 35 years because breast is the most common site of primary cancers which send metastasis to ovaries. References: 1-Nadereh Behtash, Mojgan Karimi Zarchi , Mitra Modares Gilani , Fatemeh Ghaemmaghami, Azamsadat Mousavi,and Fahimeh Ghotbizadeh. Ovarian carcinoma associated with pregnancy: A clinicopathologic analysis of 23 cases and review of the literature. BMC Pregnancy Childbirth. 2008; 8: 3. 2-Mojgan Karimi Zarchi1, Azamsadat Mousavi, Mitra Modares Gilani, Esmat Barooti, Omid Amini Rad, Fatemeh Ghaemmaghami, Soraya Teimoori, Nadereh Behtas. Fertility Sparing Treatments in Young Patients with Gynecological Cancers: Iranian Experience and Literature Review. Asian Pacific Journal of Cancer Prevention, Vol 12, 2011.

2. AComparison of the effect of levonorgestrel IUD with oral medroxyprogesterone acetate on abnormal uterine bleeding with simple endometrial hyperplasia and fertility preservation Mojgan Karimi-Zarchi1,c , Razie Dehghani-Firoozabadi2,Afsarosadat Tabatabaie3,Ziba Dehghani-Firoozabadi4, Soraya Teimoori5,Zohreh Chiti6,Atefe Dehghani71,c:Correspondence, Associate professor, Gynecology Oncology fellowship, Gynecology Oncology Department,Reproductive research center, Shahid Sadoughi University of Medical Science,Yazd,Iran.Address: Gynecology Oncology Department, Shahid Sadoughi Hospital, Shahid Ghandi BLV, Yazd, 14194, Iran; Phone: #98-351-8224000-9,Fax: #98-351-8224100,Email:drkarimi2001@yahoo.com Objective : Endometrial hyperplasia is important clinically, because it can lead to abnormal uterine bleeding (AUB) which itself can precede to endometrial cancer. Endometrial carcinoma is the most common malignancy of the female genital tract, occurring about 75%-85% in younger, perimenopousal women as hyperplasic endometrial. The treatment is hysterectomy or hormone therapy with progesterone. The aim of this study was, therefore, to compare the effect of levonorgestrel IUD (Mirena) with medroxyprogesterone acetate on simple endometrial hyperplasia for fertility preservation. Material and Methods : 40 women in reproductive age(22-47) with AUB that their endometrial biopsies reports were simple hyperplasia were enrolled in this study and then randomly divided into two groups. All patients presented with designed special checklist which was filled with satisfaction. Complete history and physical examination especially BP, BMI, breast examination, bimanual vaginal examination and trans vaginal sonography (to measure the thickness of endometrial and exclude the other pathologic lesions) were performed. In first group, treatment was performed with medroxyprogestron (20mg/daily) for 10 days and in other group Levonorgestrel IUD was prescribed. After 3 months, Trans vaginal sonography and biopsy of endometrium were done. Therefore; status of AUB and side effects of two methods along with the rate of satisfactory were evaluated. Results : Our findings showed the significant differences in the treatment of simple hyperplasia between two groups (levonorgestrel IUD group vs. MPA group) (P<0.047). Recovery of AUB in the group of Mirena was enhanced (P<0.047). Endometrial thickness was reduced in both groups (P<0.001), but reduction of endometrial in Mirena group was even more. Also, Mirena was tolerated more than MPA. Side effects of MPA was more and reached significance (P<0.003).The rate of satisfactory with Mirena was higher than medroxyprogesterone acetate and reached significance (P<0.048). Conclusion : The results of this study show that levonorgestrel IUD is more effective than MPA in treatment of simple endometrial hyperplasia and can be helpful in young women who want to preserve their fertilities. References 1-Baron YM, Craus J, Agius RC et al. Synergistic effect on the treatment of menorrhagia by endometrial biopsy followed by contemporaneous insertion of the levonorgestrel intrauterine system .Gynecol Endocrinol. 2012 Feb 4. [Epub ahead of print] 2- Gemzell-Danielsson K, Schellschmidt I, Apter D. A randomized, phase II study describing the efficacy, bleeding profile, and safety of two low-dose levonorgestrel-releasing intrauterine contraceptive systems and Mirena. Fertil Steril. 2012 Mar;97(3):616-22 .