Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis?
OBJECTIVE
Our aim was to assess the role of surgical intervention for symptom control and reproductive performance improvement in the management of subfertile women with symptomatic extensive uterine adenomyosis.


METHODS
Sixty-five subfertile women with pathology-proven extensive uterine adenomyosis, who were treated with conservative surgery or medical treatment with 6-month gonadotrophin-releasing hormone (GnRH) agonist or combination therapy, were retrospectively reviewed and their data analyzed. Twenty-eight women received conservative surgery with/without GnRH agonist (group A), and 37 received 6-month GnRH agonist therapy only (group B). Follow-up evaluations, including subjective symptoms (a self-reported 6-point verbal numeric rating scale and an analgesic usage score for dysmenorrhea) and objective parameters (serum CA125 level, and uterine size), and clinical pregnancy and successful delivery rates were made semi-annually over the ensuing 3 or more years.


RESULTS
The women in group A had higher serum CA125 levels, more infertile years, and a larger uterine size. Subjective symptom control and objective parameters were better in group A during the entire 36-month follow up compared with those in group B. Cumulative 3-year clinical pregnancy and successful delivery rates were significantly higher in group A, compared with those in group B (46.4% [13/28] versus 10.8% [4/37], P = 0.002, and 32.1% [9/28] versus 8.1% [3/37], P = 0.022, respectively).


CONCLUSIONS
Conservative surgery or combination therapy provides more effective and longer durable symptom control in the management of symptomatic women with extensive uterine adenomyosis, compared with GnRH agonist alone. Reproductive performance was also better in patients treated with conservative surgery with/without GnRH agonist.
Wang
Peng-Hui
PH
Department of Obstetrics and Gynecology, School of Medicine, National Yang-Ming University and Taipei Veterans General Hospital, Taipei, Taiwan. phwang@vghtpe.gov.tw
Fuh
Jong-Ling
JL
Chao
Hsiang-Tai
HT
Liu
Wei-Min
WM
Cheng
Ming-Huei
MH
Chao
Kuan-Chong
KC
D000328:Adult; D000700:Analgesics / Q000008:administration & dosage; D018394:CA-125 Antigen / Q000097:blood; D004412:Dysmenorrhea / Q000188:drug therapy; D004715:Endometriosis / Q000150:complications* / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists; D006801:Humans; D007247:Infertility, Female / Q000209:etiology / Q000601:surgery* / Q000628:therapy; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014599:Uterus / Q000473:pathology
D000700:Analgesics; D018394:CA-125 Antigen; D007987:Gonadotropin-Releasing Hormone