Treatment Of Infertile Adenomyosis Patients Using Levonorgestrel-Releasing Intrauterine System Or Gonadotropin-Releasing Hormone Gonist Before Frozen Blastocyst Transfer Improves Manifestations And Increases The Chances Of Pregnancy

Document Type : Original Article

Authors

1 Department of Obstetrics and Gynecology, Faculty of Medicine, Zagazig University, Egypt.

2 Associate professor, zagazig University, Egypt

3 Assistant Professor Obstetrics and Gynecology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt; Associate professor obstetrics and Gynecology college of medicine Sulaiman AlRajhi University Kingdom of Saudi Arabia.

10.21608/ebwhj.2025.354610.1418

Abstract

Objectives: To examine the effects of Levonorgestrel-releasing Intrauterine System (LNG-IUS) and Gonadotropin-releasing Hormone agonist (GnRHa) therapy on adenomyosis symptoms and the outcomes of frozen blastocyst transfer (FBT).
Patients & Methods: In this study, 184 women with adenomyosis who underwent ICSI and achieved good quality FB were randomly divided into two groups (n= 92). They received either LNG-IUS or GnRHa (3.75mg monthly for three months) before FBT. Patients were monitored for changes in menstrual patterns, PEG scale (pain intensity, enjoyment of life, general activity), and FBT outcomes.
Results: At 3-m after treatment 62 women of LNG-IUS group and 10 of GnRHa group resumed normal menstrual pattern (P<0.001) and 30 women of LNG-IUS group and 25 of GnRHa group had oligomenorrhea (P= 0.421), while 57 women of GnRHa group developed amenorrhea. Pain frequency and severity significantly decreased in both groups at the end of treatment. Positive chemical pregnancy rate was 67.4%, while clinical pregnancy rate was 54.3% with insignificantly higher chemical, but significantly (P= 0.038) higher clinical pregnancy rates among women of GnRH group. The ectopic pregnancy rates were 4.7% and 1.8% and the early pregnancy loss rates were 23.3% and 31.6% among women of LNG-IUS and GnRHa groups, respectively with insignificant differences between both therapies.
Conclusion: Medical management using LNG-IUS or GnRHa significantly controlled adenomyosis manifestation in terms of pain; bleeding and menstrual pattern in infertile adenomyosis women planned to have FBT, but LNG-IUS provided superior outcomes. Also, LNG-IUS preparation optimized outcomes of FBT with results comparable to the GnRHa treatment.

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