The following is a summary of the “Pituitary suppression with GnRH agonists before ART may be insufficient to treat women with severe adenomyosis,” published in the January 2023 issue of Reproductive Biomedicine Online by Cozzolino, et al.

After three months of depot GnRHa treatment for severe adenomyosis in four patients, a 21-day aromatase inhibitor treatment was tried. After GnRHa therapy, baseline and post-aromatase inhibitor oestradiol levels in the blood were measured. In addition, women underwent an IVF cycle and had their own or a donor’s oocytes transferred. The primary results were rates of pregnancy and sustained pregnancies. A secondary outcome of aromatase inhibitor treatment was oestradiol concentration in the blood.

Hyperestrogenism, caused by local production from the lesions, was present in patients with severe adenomyosis despite long-term treatment with GnRHa. Patients with adenomyosis who had previous embryo transfer failures benefited from treatment with an aromatase inhibitor because it decreased hyperestrogenism and enhanced clinical outcomes. Before receiving assisted reproductive technology, letrozole or a combination of GnRHa and letrozole would benefit women with severe adenomyosis. 

GnRHa treatment alone may not suppress estrogen production by adenomyotic lesions in women with severe adenomyosis. Therefore, oestradiol levels should be monitored regularly in patients with severe adenomyosis on long-term GnRHa therapy. The medical management of adenomyotic lesions may also involve other methods besides GnRHa. Safe and effective, letrozole can boost IVF success rates for adenomyosis patients.

Source: sciencedirect.com/science/article/abs/pii/S1472648322007167