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. Materials and 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 CA 125, 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. Copyright (c) 2012, Taiwan Association of Obstetrics & Gynecology. Published by Elsevier Taiwan LLC. All rights reserved.