Publication:

Fertility outcome following ovarian stimulation in infertile women having pretreatment with levonorgestrel releasing intrauterine system versus dienogest for symptomatic adenomyosis

Background Adenomyosis is an emerging enigmatic uterine disease that negatively impacts women's fertility. Conservative treatments, including medical management, offer hope to preserve future fertility but remain challenging, especially in low-resource settings. Since 2019, at our center, infertile women diagnosed with symptomatic adenomyosis have been pre-treated with either a Levonorgestrel-Releasing Intrauterine System (LNG-IUS) or Dienogest based on physician preference. Following symptomatic relief, ovarian stimulation protocols were applied to optimize the chances of natural conception without assisted reproductive technologies (ART). This study aimed to compare fertility outcomes following ovarian stimulation in infertile women with symptomatic adenomyosis who had been pre-treated with LNG-IUS versus Dienogest.

Methods This quasi-experimental study was conducted at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, from January 2024 to December 2024. Infertile women with previously diagnosed symptomatic adenomyosis, symptomatically relieved by LNG-IUS or Dienogest, were enrolled. Following enrolment, LNG-IUS devices were removed and Dienogest was discontinued. Participants were divided into two groups: Group A (pre-treated with LNG-IUS) and Group B (pre-treated with Dienogest) and both underwent ovarian stimulation using oral ovulogens.

Results Both groups were comparable in baseline socio demographic, biochemical and biophysical criteria. Ovulation and pregnancy rate in each cycle were higher in LNG-IUS group than Dienogest group though this difference was not statistically significant (p>0.05).

Conclusions Pre-treatment with LNG-IUS prior to ovarian stimulation may offer better fertility outcomes compared to Dienogest, though larger studies involving more cycles and multicenter collaboration are necessary to confirm these findings.