Overcoming adenomyosis in in vitro fertilization: a case series

Anushka V. Mehta, Grishma Desai, Mounica V. Gotluru
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2026 · vol. 15(4) , pp. 1360–1363 · doi:10.18203/2320-1770.ijrcog20260898 · W7141878400
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⚙ AI-generated summary by claude@2026-06, 2026-06-26 ⓘ

This case series evaluated three women with adenomyosis undergoing IVF with a GnRH antagonist protocol and freeze-all strategy, finding all achieved ongoing clinical pregnancy after frozen embryo transfer.

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⚙ AI-generated deep summary by claude@2026-07, 2026-07-09 · read from full text ⓘ

This retrospective case series studied three women with imaging-confirmed adenomyosis undergoing IVF using a GnRH antagonist stimulation protocol followed by a freeze-all approach, with frozen embryo transfer (FET) after subsequent GnRH agonist down-regulation and hormone replacement. The authors evaluated clinical characteristics, stimulation parameters, embryological outcomes, and pregnancy outcomes, reporting satisfactory oocyte yield and embryo development in all participants. All three patients achieved ongoing clinical pregnancy, with the paper concluding that favorable IVF outcomes were possible with this specific antagonist-plus-freeze-all and FET strategy, while noting that larger prospective studies are needed to validate the findings. This paper is centrally about adenomyosis — it presents a retrospective case series describing an IVF protocol sequence (GnRH antagonist, freeze-all, then FET) in imaging-confirmed adenomyosis patients.

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Abstract

Adenomyosis is increasingly diagnosed in infertile women and is associated with adverse in vitro fertilization (IVF) outcomes. Individualizing ovarian stimulation and embryo transfer strategies may improve reproductive outcomes. This retrospective case series includes three women with imaging-confirmed adenomyosis who underwent IVF using a gonadotropin-releasing hormone (GnRH) antagonist protocol with a freeze-all strategy, followed by frozen embryo transfer (FET). Clinical characteristics, stimulation parameters, embryological outcomes, and pregnancy outcomes were evaluated. All patients completed ovarian stimulation with satisfactory oocyte yield and embryo development. Frozen embryo transfer was performed following GnRH agonist down-regulation and hormone replacement therapy. All three patients achieved ongoing clinical pregnancy. Favorable IVF outcomes can be achieved in women with adenomyosis using an antagonist protocol combined with a freeze-all strategy and frozen embryo transfer. Larger prospective studies are required to validate these findings.
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Overcoming adenomyosis in in vitro fertilization: a case series DOI: https://doi.org/10.18203/2320-1770.ijrcog20260898Keywords: Adenomyosis, In vitro fertilization, GnRH antagonist, Case series, Frozen embryo transfer, Freeze-allAbstract Adenomyosis is increasingly diagnosed in infertile women and is associated with adverse in vitro fertilization (IVF) outcomes. Individualizing ovarian stimulation and embryo transfer strategies may improve reproductive outcomes. This retrospective case series includes three women with imaging-confirmed adenomyosis who underwent IVF using a gonadotropin-releasing hormone (GnRH) antagonist protocol with a freeze-all strategy, followed by frozen embryo transfer (FET). Clinical characteristics, stimulation parameters, embryological outcomes, and pregnancy outcomes were evaluated. All patients completed ovarian stimulation with satisfactory oocyte yield and embryo development. Frozen embryo transfer was performed following GnRH agonist down-regulation and hormone replacement therapy. All three patients achieved ongoing clinical pregnancy. Favorable IVF outcomes can be achieved in women with adenomyosis using an antagonist protocol combined with a freeze-all strategy and frozen embryo transfer. Larger prospective studies are required to validate these findings. Metrics References Ge L, Li Y, Zhou J, Zhao X, Chen X, Wang W, et al. Effect of different treatment protocols on in vitro fertilisation/intracytoplasmic sperm injection (IVF/ICSI) outcomes in adenomyosis women: a systematic review and meta-analysis. BMJ Open. 2024;14(7):e077025. DOI: https://doi.org/10.1136/bmjopen-2023-077025 Pados G, Gordts S, Sorrentino F, Nisolle M, Nappi L, Daniilidis A. Adenomyosis and infertility: a literature review. Medicina. 2023;59(9):1551. DOI: https://doi.org/10.3390/medicina59091551 Cozzolino M, Tartaglia S, Pellegrini L, Troiano G, Rizzo G, Petraglia F. The effect of uterine adenomyosis on IVF outcomes: a systematic review and meta-analysis. Reprod Sci. 2022;29(11):3177-93. DOI: https://doi.org/10.1007/s43032-021-00818-6 Wu HM, Tsai TC, Liu SM, Pai AH, Chen LH. The current understanding of molecular mechanisms in adenomyosis-associated infertility and the treatment strategy for assisted reproductive technology. Int J Mol Sci. 2024;25(16):8937. DOI: https://doi.org/10.3390/ijms25168937 Wu Y, Huang J, Zhong G, Lan J, Lin H, Zhang Q. Long-term GnRH agonist pretreatment before frozen embryo transfer improves pregnancy outcomes in women with adenomyosis. Reprod Biomed Online. 2022;44(2):380-8. DOI: https://doi.org/10.1016/j.rbmo.2021.10.014 Zhang W, Han B, Ma C, Qiao J. Effect of GnRH-a pretreatment before frozen-thawed embryo transfer on pregnancy outcome of adenomyosis-associated infertile patients with 56 cm3≤ uterine volume≤ 100 cm3. Ann Transl Med. 2022;10(9):509. DOI: https://doi.org/10.21037/atm-21-6247 Steinmann M, Anthon C, Schwartz AS, Mackens S, Blockeel C, Kalaitzopoulos DR, et al. GnRH agonist pretreatment prior to frozen embryo transfer in women with adenomyosis: a systematic review and meta-analysis. Reprod BioMed Online. 2025;51(5). DOI: https://doi.org/10.1016/j.rbmo.2025.105075

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