Pregnancy rate in women with adenomyosis undergoing fresh or frozen embryo transfer cycles following gonadotropin-releasing hormone agonist treatment.
OBJECTIVE
To determine the preferred regimen for women with adenomyosis undergoing in vitro fertilization (IVF), we compared the IVF outcomes of fresh embryo transfer (ET) cycles with or without gonadotropin-releasing hormone (GnRH) agonist pretreatment and of frozen-thawed embryo transfer (FET) cycles following GnRH agonist treatment.


METHODS
This retrospective study included 241 IVF cycles of women with adenomyosis from January 2006 to January 2012. Fresh ET cycles without (147 cycles, group A) or with (105 cycles, group B) GnRH agonist pretreatment, and FET cycles following GnRH agonist treatment (43 cycles, group C) were compared. Adenomyosis was identified by using transvaginal ultrasound at the initial workup and classified into focal and diffuse types. The IVF outcomes were also subanalyzed according to the adenomyotic region.


RESULTS
GnRH agonist pretreatment increased the stimulation duration (11.5±2.1 days vs. 9.9±2.0 days) and total dose of gonadotropin (3,421±1,141 IU vs. 2,588±1,192 IU), which resulted in a significantly higher number of retrieved oocytes (10.0±8.2 vs. 7.9±6.8, p=0.013) in group B than in group A. Controlled ovarian stimulation for freezing resulted in a significantly higher number of retrieved oocytes (14.3±9.2 vs. 10.0±8.2, p=0.022) with a lower dose of gonadotropin (2,974±1,112 IU vs. 3,421±1,141 IU, p=0.037) in group C than in group B. The clinical pregnancy rate in group C (39.5%) tended to be higher than those in groups B (30.5%) and A (25.2%) but without a significant difference.


CONCLUSIONS
FET following GnRH agonist pretreatment tended to increase the pregnancy rate in patients with adenomyosis. Further large-scale prospective studies are required to confirm this result.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
Chan Woo
CW
Park
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
Min Hye
MH
Choi
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
Kwang Moon
KM
Yang
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.
In Ok
IO
Song
Adenomyosis; Embryo transfer; Gonadotorpin-releasing hormone; In vitro fertilization
Biol Reprod. 1997 Sep;57(3):514-9
9282984
Gynecol Endocrinol. 2013 Dec;29(12):1026-30
24006906
Chin Med J (Engl). 2000 May;113(5):442-5
11776101
J Reprod Med. 1999 Aug;44(8):741-4
10483548
Hum Reprod. 2014 May;29(5):964-77
24622619
Fertil Steril. 2010 Jun;94(1):85-9
19361790
Radiology. 1989 May;171(2):531-4
2704819
Eur J Obstet Gynecol Reprod Biol. 2013 Oct;170(2):419-22
24021319
Proc Natl Acad Sci U S A. 2003 Mar 4;100(5):2963-8
12601161
Best Pract Res Clin Obstet Gynaecol. 2006 Aug;20(4):511-21
16563870
Fertil Steril. 1994 Jan;61(1):171-2
8293832
Fertil Steril. 2011 Mar 1;95(3):1133-6
21067721
Hum Reprod. 2004 Feb;19(2):352-6
14747179
Fertil Steril. 2008 May;89(5 Suppl):1357-63
17681328
Eur J Obstet Gynecol Reprod Biol. 2011 Oct;158(2):229-34
21664029
Obstet Gynecol Int. 2012;2012:786132
22242025
Eur J Obstet Gynecol Reprod Biol. 2010 Jul;151(1):62-5
20409633
Hum Reprod. 2010 Mar;25(3):642-53
20008888
Fertil Steril. 2011 Oct;96(4):943-50
21821247