Advanced Management of Severe Adenomyosis in IVF: A Personalized Approach With Extended GnRH Agonist and Letrozole Therapy.

Abstract

Objective: The objective of this study is to evaluate the effectiveness of prolonged GnRH agonist (GnRH-a) suppression combined with letrozole and intensive luteal phase support in a patient with severe adenomyosis undergoing frozen-thawed embryo transfer (FET).

Design: The study design was a case report.

Setting: The setting was a tertiary referral in vitro fertilization (IVF) clinic.

Subjects: The subject was a 41-year-old woman with a history of primary infertility with severe adenomyosis and endometriosis. Her partner presented with nonobstructive azoospermia.

Exposure: Following micro-TESE, ovarian stimulation, and ICSI, the patient received prolonged combined GnRH-a and letrozole suppression before two attempts of single euploid frozen embryo transfer (eFET).

Main outcome measures: The main outcome measure was pregnancy outcome.

Results: The first eFET cycle with 3 months of suppression resulted in an early miscarriage at 7 weeks. In the second cycle, a prolonged 5-month suppression led to a significant reduction of the uterine size, lower serum estradiol levels, and optimal endometrial preparation, achieving an ongoing pregnancy and delivery of a healthy baby at 36 weeks of gestation.

Conclusion: This case supports the potential benefit of extended GnRH-a and letrozole suppression with intensive luteal phase support for patients with severe adenomyosis, suggesting that individualized protocols may be beneficial and warrant further investigation in similar complex cases.