title: Successful twin pregnancy achieved by assisted reproductive technology in a patient with polycystic ovary syndrome with complex atypical endometrial hyperplasia treated with levonorgestrel-releasing intrauterine system.
abstract: Polycystic ovary syndrome (PCOS) is one of the most common reproductive endocrinopathy and a major cause of infertility. PCOS may be associated with chronic anovulation and endometrial hyperplasia. Conservative treatment should be considered in young women wishing to preserve their fertility. Standard treatment for complex endometrial hyperplasia is the use of high-dose progesterone, whereas we preferred levonorgestrel-releasing intrauterine system (LNG-IUS) as a last resort in our patient who was resistant to oral gestagens. We present a case with complex atypical endometrial hyperplasia treated conservatively in a long-term period first by oral gestagens, then by LNG-IUS. In our case, LNG-IUS was more effective than oral systemic progestins, not only for reducing the menstrual blood loss but also for improving the pathological findings. After extraction of LNG-IUS rapid achievement of pregnancy was carried out by intracytoplasmic sperm injection and embryo transfer and she took home twin babies. To the best of our knowledge, this is the first successful twin pregnancy case with ICSI and ET in a patient with oral gestagen resistant endometrial complex/atypical hyperplasia achieved after application of LNG-IUS. In complex atypical hyperplasia, LNG-IUS should be kept in mind as an effective alternative treatment modality before assisted reproductive technology (ART).
authors.affiliation: Gulhane Military Medical Faculty, Obstetrics and Gynecology Department, 06018 Etlik, Ankara, Turkey. ercanmutlu@yahoo.com
authors.forename: Cihangir Mutlu
authors.initials: CM
authors.lastname: Ercan
authors.forename: Namik Kemal
authors.initials: NK
authors.lastname: Duru
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sakinci
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Alanbay
authors.forename: Kazim Emre
authors.initials: KE
authors.lastname: Karasahin
authors.forename: Iskender
authors.initials: I
authors.lastname: Baser
mesh_terms: D000328:Adult; D004714:Endometrial Hyperplasia / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007436:Intrauterine Devices, Medicated; D016912:Levonorgestrel / Q000008:administration & dosage*; D011085:Polycystic Ovary Syndrome / Q000188:drug therapy* / Q000503:physiopathology; D011247:Pregnancy; D011272:Pregnancy, Multiple; D027724:Reproductive Techniques, Assisted
chemical_list: D016912:Levonorgestrel