Gonadotropin-releasing hormone agonists and laparoscopy in the treatment of adenomyosis with infertility.

OBJECTIVE

To study the role and value of gonadotropin-releasing hormone agonists (GnRH-a) and laparoscopy for the treatment of adenomyosis with infertility.

METHODS

Four cases were seen with adenomyosis and infertility, 3 of these cases also presented local adenomyomata in the posterior uterine wall. GnRH-a Triptorelin (decapeptyl) or Goserelin (Zoladex) therapy was instituted for six months before laparoscopic surgery for coexisting pelvic pathologic infertility factors in one case and after laparoscopic surgery in three cases.

RESULTS

All cases remained amenorrheic during GnRH-a therapy. After the GnRH-a therapy, all enlarged uterus (7-10 weeks gestation size) all decreased to normal or near normal size; menstruation returned in 80-90 days and three cases conceived within four menstrual periods after cessation of treatment. In the 4 cases one pregnancy resulted in the birth of a healthy 3150 g male newborn at 38 weeks gestation by cesarean section; one pregnancy was terminated after adenomyomectomy by emergency cesarean section at 30 weeks gestation because of threatened rupture of uterus; one case was then normal at 28 weeks pregnancy; the last case had 2 resumptive menstrual periods and was still being followed up.

CONCLUSIONS

GnRH-a is markedly efficient in reducing adenomyotic uterine size, facilitates uterine or endometrial receptivity for embryos and enhances uterine ability to maintain pregnancy. For adenomyomata associated with infertility, GnRH-a instead of surgical removal of lesions, which are deep in the myometrium, may avoid uterine rupture when pregnancy occurs. For infertility, GnRH-a treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases.