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

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.