{"paper_id":"b5a31139-6e94-42de-a344-954a31121163","body_text":"Abstract\nTo assess the treatment efficacy of adenomyoma and improvement in implantation receptivity associated with the levonorgestrel-releasing intrauterine system (LNG-IUS) combined with adenomyoma resection. Fifty subjects (control group) underwent laparoscopic adenomyoma excision and received gonadotropin-releasing hormone (GnRH) agonists, and 201 subjects (experimental group) underwent laparoscopic adenomyoma resection and received GnRH agonists combined with the LNG-IUS. Pipelle endometrial biopsies were obtained in the mid-luteal phase, before the operation, and 19 months after the operation. Menstrual blood loss was measured using a pictorial blood loss assessment chart. Pain intensity during menstruation was evaluated on a 10-point visual analog scale (VAS). The volume of uterus was measured through ultrasound. Quantification of HOXA10 promoter methylation was performed through bisulfite sequencing polymerase chain reaction (BSP). Real-time polymerase chain reaction analyzed the expression levels of endometrial HOXA10-mRNA and leukemia inhibitory factor (LIF)-mRNA. After surgery, the scores for dysmenorrhea and menorrhagia were significantly improved, and the volume of the uterus was obviously reduced (all p < 0.01). The mean number of methylated CpG sites, level of endometrial HOXA10-mRNA, and level of endometrial LIF-mRNA were 5.6 ± 1.7 versus 3.9 ± 1.3, 0.8 ± 0.2 versus 0.9 ± 0.3, and 0.8 ± 0.2 versus 1.0 ± 0.2, respectively, in the control group versus the experimental group at 19 months after surgery, and significant improvements were observed in the experimental group (p < 0.001, p = 0.034, p < 0.001). Laparoscopic adenomyoma excision and GnRH agonists can alleviate the symptoms, reduce the number of methylated CpG sites in HOXA10, and improve endometrial HOXA10-mRNA and endometrial LIF-mRNA levels. When combined with subsequent use of the LNG-IUS, better efficacy can be achieved.\nSimilar content being viewed by others\nReferences\nGarcia L, Isaacson K. Adenomyosis: review of the literature. J Minim Invasive Gynecol. 2011;18(4):428–37.\nBenagiano G, Brosens I. History of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):449–63.\nGaravaglia E, Audrey S, Annalisa I, Stefano F, Iacopo T, et al. Adenomyosis and its impact on women fertility. Iran J Reprod Med. 2015;13(6):327–36.\nDevlieger R, D’Hooghe T, Timmerman D. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 2003;19(2):139–47.\nHuang HY, Chan SH, Wu JH, et al. 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This study was supported by the Fujian hygiene fund of youth research (Grant No. 2016-1-32).\nAuthor information\nAuthors and Affiliations\nCorresponding author\nEthics declarations\nEthical Statements\nEthics committee approval was obtained from the Institutional Ethics Committee of Fujian Provincial Hospital for the commencement of the study.\nConflict of Interest\nThe authors declare that they have no conflict of interest.\nAdditional information\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nRights and permissions\nAbout this article\nCite this article\nWu, Q., Lian, Y., Chen, L. et al. Alleviation of Symptoms and Improvement of Endometrial Receptivity Following Laparoscopic Adenomyoma Excision and Secondary Therapy with the Levonorgestrel-releasing Intrauterine System. Reprod. Sci. 27, 1259–1265 (2020). https://doi.org/10.1007/s43032-019-00130-4\nReceived:\nAccepted:\nPublished:\nVersion of record:\nIssue date:\nDOI: https://doi.org/10.1007/s43032-019-00130-4","source_license":"CC0","license_restricted":false}