{"paper_id":"d3c457a7-e8ef-483a-bf63-f7f35f94c3d6","body_text":"Abstract\nIntroduction\nEndometrioma, even when asymptomatic, may adversely affect reproductive outcomes by interfering with folliculogenesis, oocyte quality and the pelvic microenvironment. Suppression of endometriotic activity with gonadotropin-releasing hormone (GnRH) analogue has been utilized to improve the likelihood of spontaneous conception. Recently, oral GnRH antagonists such as Elagolix have emerged as less invasive alternatives to injectable depot medications. This study aims to compare the efficacy of oral Elagolix versus intramuscular Leuprolide Depot in facilitating spontaneous conception, reducing endometrioma size, alleviating symptoms and improving patient compliance.\nMethods\nA retrospective cohort study was conducted on 100 women with both asymptomatic and symptomatic ovarian endometriomas (< 3 cm), patent fallopian tubes and partners with normal semen parameters. Group A (n = 50) received oral Elagolix 200 mg twice daily for 3 months, while Group B (n = 50) received Leuprolide Depot 3.75 mg monthly for the same duration. Patients were monitored monthly and followed for 12-months post-treatment for spontaneous conception, symptom relief, cyst size reduction and compliance. Primary outcome was defined as spontaneous conception rate within 12 months of treatment cessation. Secondary outcomes involved patient compliance (treatment adherence), symptom improvement (notably dysmenorrhea) and reduction in endometrioma size on transvaginal sonography.\nResults\nBaseline demographics and reproductive characteristics were comparable between the Elagolix and leuprolide groups. Spontaneous conception occurred in 36% of the Elagolix group compared to 12.5% in the Leuprolide group (p = 0.028). Compliance was 100% in the Elagolix group, while 20% of patients in the Leuprolide group were lost to follow-up. Both treatments resulted in symptomatic relief and cyst size reduction; however, Elagolix demonstrated more pronounced benefits in both domains. Additionally, patients in the Elagolix group reported earlier return of regular menstrual cycles (2.85 months vs 4.23 months in leuprolide arm), which may have contributed to the higher conception rates observed. The greater ease of administration and reduced need for clinical visits likely played a key role in enhancing adherence among Elagolix users.\nConclusion\nOral Elagolix is superior to Leuprolide Depot in enhancing spontaneous conception rates, reducing endometrioma size, relieving symptoms and ensuring better treatment adherence. Given its ease of administration and quicker return to ovulatory function, Elagolix may be the preferred option in fertility-focused management of asymptomatic endometriomas.\nSimilar content being viewed by others\nChange history\n10 June 2026\nThe original version of this article was revised: to update the spelling Elagolix.\nReferences\nTaylor HS, Giudice LC, Lessey BA, et al. Treatment of endometriosis-associated pain with elagolix, an oral GnRH antagonist. N Engl J Med. 2017;377(6):28–40.\nPaoletti AM, Neri M, Pilloni M, et al. Pharmacokinetics of GnRH agonists and antagonists in endometriosis. Res Gate Preprint. 2025;25(5):23–6.\nMikuš M, ŠpremGoldštajn M, Laganà AS, et al. Medical options for endometriosis-related pelvic pain: A review. Pharmaceuticals (Basel). 2023;16(9):1315–20.\nPerricos A, Wenzl R. Efficacy of elagolix in endometriosis treatment. Expert Opin Pharmacother. 2017;18(11):1093–101.\nYan H, Shi J, Li X, et al. 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Obstet Gynecol. 2025;146(2):e23–35.\nFunding\nNo external funds have been received for this article.\nAuthor information\nAuthors and Affiliations\nContributions\nAshish Kale and Ashwini Kale were the primary investigators who were involved in patient interaction, data collection and analysis. Avir Sarkar did the data analysis. Avir Sarkar, Amiya Das and Suman Sandeep Samal helped in writing the manuscript.\nCorresponding author\nEthics declarations\nConflict of interest\nNone declared.\nEthics Approval\nInstitutional Ethics Committee approval has been obtained prior to the initiation of this study (BSMC/Aca/19/24).\nInformed consent\nNot applicable as a retrospective study and data analysis.\nAdditional information\nPublisher's Note\nSpringer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.\nAshish Kale: Director, Ashakiran Hospital and ASHA IVF Centre; Ashwini Kale: Director, Ashakiran Hospital and ASHA IVF Centre; Avir Sarkar: Assistant Professor, Department of Obstetrics and Gynaecology, AIIMS Kalyani; Amiya Das: Senior Resident, Department of Obstetrics and Gynaecology, AIIMS Kalyani; Suman Sandeep Samal: Junior Resident, Department of Obstetrics and Gynaecology, AIIMS Kalyani.\nRights and permissions\nSpringer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.\nAbout this article\nCite this article\nKale, A., Kale, A., Sarkar, A. et al. Comparison of the Efficacy of Oral Elagolix Versus Leuprolide Depot: Optimizing Natural Conception in Women with Endometrioma. J Obstet Gynecol India (2026). https://doi.org/10.1007/s13224-025-02328-w\nReceived:\nAccepted:\nPublished:\nVersion of record:\nDOI: https://doi.org/10.1007/s13224-025-02328-w","source_license":"CC0","license_restricted":false}