Use of hormone therapy before IVF in women with adenomyosis

This paper compared pregnancy rates in women with adenomyosis undergoing in-vivo fertilization. Authors reported higher pregnancy rates among women who underwent frozen-thawed embryo transfer with GnRH than women who underwent fresh embryo transfer with GnRH.

Adenomyosis is a disease where the inner layer of the uterus breaks through the muscle layer of the uterus. This causes painful periods, abnormal bleeding, and an enlarged uterus. Adenomyosis is becoming more common in infertile women undergoing in-vitro fertilization (IVF). Studies have shown that a gonadotropin-releasing hormone (GnRH) agonist can improve pregnancy rates. GnRH agonists are a type of hormone therapy that work to stimulate the ovaries to release eggs. After the eggs are obtained and fertilized, they can be transferred to the uterus immediately (fresh) or at a later stage (frozen-thawed). It has been suggested that the use of GnRH agonist before IVF is more effective with frozen-thawed embryo transfer than with fresh embryo transfer. 

295 IVF cycles of 241 infertile women with adenomyosis were analyzed. 116 women had fresh embryo transfer without GnRH agonist. 87 women had fresh embryo transfer with GnRH agonist. 38 women had frozen-thawed embryo transfer with GnRH agonist. The GnRH agonist used was goserelin (Zoladex). The rates of pregnancy were compared between groups.

Overall, women with fresh embryo transfer receiving the GnRH agonist had a higher number of eggs retrieved (10) than women who had fresh embryo transfer only (7.9). Among women who had fresh embryo transfer, there was no significant effect of GnRH agonist use on fertilization and pregnancy rates.

Among women who received GnRH agonist, those who had frozen-thawed embryo transfer had a higher number of eggs retrieved (14.3) than those who had fresh embryo transfer (10). The pregnancy rate was 10% higher in women who had frozen-thawed embryo transfer (39.5%) than in women who had fresh embryo transfer (30.5%). However, this difference was not statistically significant.

The authors concluded that frozen-thawed embryo transfer with GnRH agonist before IVF tended to increase pregnancy rate in women with adenomyosis. However, the difference in pregnancy rates was not statistically significant and further studies are needed to confirm these results.