Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: long-term follow-up in a series of nine patients.
OBJECTIVE
This paper reports the long-term follow-up (62-83 months) of women with unexplained subfertility secondary to severe adenomyosis treated with the combination of conservative surgery and gonadotropin releasing hormone agonist (GnRH agonist) therapy.


METHODS
A retrospective study included nine patients with a history of > 3 years of unexplained infertility who had extensive uterine adenomyosis. These nine couples were diagnosed with unexplained infertility after excluding other possible causes, such as the male factor, ovulation disorders, structural abnormality, and infections. All were essentially normal except for presumed uterine adenomyosis and elevated serum levels of CA125. All underwent a careful excision of the adenomyosis tissue using a microsurgical technique, and then a six-month course of GnRH agonist therapy. The outcome evaluations included serum level of CA125, degree of dysmenorrhea, and rate of spontaneous pregnancy.


RESULTS
Postoperative follow-up showed that the severity of dysmenorrhea was significantly improved. The improvement scale was positively correlated with a decline in the serum level of CA125. A postoperative serum CA125 decreased to less than 10.00 IU/mL predicted well the spontaneous pregnancy rate, especially during the therapy. In the end, only two women became pregnant and finally delivered viable babies in this study.


CONCLUSIONS
Although the combination of careful conservative surgery and GnRH agonist therapy might provide some benefits in patients with unexplained infertility and presumed severe adenomyosis, two-thirds of the patients still failed to become pregnant. The postoperative serum level of CA125 could predict the future pregnancy rate.
Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.
Ben-Shian
BS
Huang
Kok-Min
KM
Seow
Kuan-Hao
KH
Tsui
Chen-Yu
CY
Huang
Yen-Feng
YF
Lu
Peng-Hui
PH
Wang
D062788:Adenomyosis / Q000097:blood* / Q000150:complications / Q000628:therapy*; D000328:Adult; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D018394:CA-125 Antigen / Q000097:blood*; D004412:Dysmenorrhea / Q000097:blood / Q000209:etiology; D005260:Female; D005300:Fertility Agents, Female / Q000627:therapeutic use; D005500:Follow-Up Studies; D007987:Gonadotropin-Releasing Hormone / Q000037:antagonists & inhibitors; D017273:Goserelin / Q000627:therapeutic use; D006801:Humans; D007247:Infertility, Female / Q000097:blood* / Q000150:complications / Q000628:therapy*; D016729:Leuprolide / Q000627:therapeutic use; D008866:Microsurgery; D011237:Predictive Value of Tests; D011247:Pregnancy; D018873:Pregnancy Rate; D012189:Retrospective Studies; D013997:Time Factors
D018931:Antineoplastic Agents, Hormonal; D018394:CA-125 Antigen; D005300:Fertility Agents, Female; D017273:Goserelin; D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide