Fertility sparing treatment in an infertile patient with severe adenomyosis and a uterine fibroid: a case report

Fertility sparing treatment in an infertile patient with severe adenomyosis and a uterine fibroid: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20231254Keywords: Adenomyosis, Uterine fibroids, Leiomyomas, Infertility, Pregnancy, Case reportAbstract Adenomyosis and uterine leiomyoma are benign lesions of the myometrium. Adenomyosis is a myometrial lesion characterised by the presence of ectopic endometrium with or without hyperplasia of the surrounding myometrium. Uterine fibroids, also called leiomyomas or myomas, are benign tumours that arise from the smooth muscle of the uterus. A 33-year-old nulliparous woman attended the clinic with primary infertility for 18 years. She was diagnosed with severe adenomyosis and uterine fibroids. She conceived successfully after undergoing in vitro fertilization (IVF) and a downregulated frozen embryo transfer (FET). Adenomyosis is a common cause of primary and secondary dysmenorrhea associated with infertility in young, nulliparous women. Fertility preservation is the primary goal in this population. Medical management is essential, and a properly downregulated and planned FET is the treatment of choice. Metrics References Sasamori Y, Takehara K, Terashima T, Onodera T, Yatsuki K, Nakagawa I et al. A case of adenomyosis with leiomyoma that was effectively treated with relugolix and kamishoyosan add-on therapy. BMC Women's Health. 2021;21(1):1-5. Taran FA, Weaver AL, Coddington CC, Stewart EA. Characteristics indicating adenomyosis coexisting with leiomyomas: a case–control study. Human Reproduct. 2010;25(5):1177-82. Zhang X, Bangchun Lu, Xiufeng H, Hong Xu, Zhou C, Lin J. Innervation of endometrium and myometrium in women with painful adenomyosis and uterine fibroids. Fertil Steril. 2010;94(2):730-7. Arai N, Yachi K, Ishihara R, Fukushima T. Adenomyosis-associated recurrent acute cerebral infarction mimicking Trousseau’s syndrome: A case study and review of literature. Surg Neurol Int. 2022;13. Freytag D, Günther V, Maass N, Alkatout I. Uterine fibroids and infertility. Diagnostics. 2021;12;11(8):1455. Bedrick BS, Kazarian GS, Greenwade MM, Spies N, Chen T, Maluf H et al. Adenomyosis presenting as a molar pregnancy: A case report. Gynecologic Oncol Rep. 2020;32. Benagiano G, Brosens I. History of adenomyosis. Best Practice Res Clin Obstetr Gynaecol. 2006;20(4):449-63. Xu T, Yue L, Lili J, Qifang L, Kuiran L. Subserous Cystic Adenomyosis: A Case Report and Review of the Literature. Frontiers Surg. 2022;9. Feng M, Chen LH, Hsu LT, Wu HM. Segmented in vitro fertilization and frozen embryo transfer in dienogest-treated patient with adenomyosis: A case report and lierature review. Taiw J Obstetr Gynecol. 2022;61(5):906-8. Tamura H, Kishi H, Kitade M, Asai‐Sato M, Tanaka A, Murakami T et al. Complications and outcomes of pregnant women with adenomyosis in Japan. Reproduct Med Biol. 2017;16(4):330-6. Hunjan T, Davidson A. An unexpected diagnosis of adenomyosis in the subfertile woman. Case Rep. 2015;bcr2014209012. Takamura M, Koga K, Harada M, Hirota Y, Fujii T, Osuga Y. A case of hemorrhagic shock occurred during dienogest therapy for uterine adenomyosis. J Obstetr Gynaecol Res. 2020;46(12):2696-700. Ernest A, Mwakalebela A, Mpondo BC. Uterine leiomyoma in a 19-year-old girl: Case report and literature review. Malawi Med J. 2016;28(1):31-3. Viva W, Juhi D, Kristin A, Micaela M, Marcus B, Ibrahim A et al. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Rep. 2021;15:1-6. Myounghwan K. Spontaneous complete regression of large uterine fibroid after the second vaginal delivery: Case report. Medicine. 2018;97(45).