Successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and subsequent gonadotropin-releasing hormone agonist: a case report.
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A case report details successful pregnancy following cytoreductive surgery for deep adenomyosis and subsequent gonadotropin-releasing hormone agonist therapy.
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Abstract
Adenomyosis is a common pathologic finding significantly related to the menstrual and reproductive characteristics of women. Although noted during younger reproductive years, it usually presents in women over 35 years of age. For those with a strong desire to preserve fertility, there is presently no uniform agreement on the most appropriate therapeutic methods to manage the condition. Herein, we present a case of long-term secondary infertility with successful pregnancy after treatment of deep adenomyosis with cytoreductive surgery and a subsequent six-month course of gonadotropin-releasing hormone agonist (GnRHa) therapy. For those who want to conceive, early combined GnRHa therapy immediately following cytoreductive surgery and a delay of four to six months before attempting to fall pregnant is advisable. This is because adenomyosis tends to recur rapidly and the myometrium can be significantly disrupted during surgery. The major obstetric complications, such as uterine atony, rupture or placenta accreta, do not increase with adenomyosis during pregnancy. Although two events of threatened abortion and one of preterm labor were encountered during the pregnancy course, a healthy 2,900-g female was delivered by low transverse cesarean section at term. A cesarean section was performed because of previous large cytoreductive surgery. In contrast to GnRHa therapy alone, we report an effective alternative to hysterectomy in order to maintain fertility and achieve successful pregnancy.
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Cited by (27)
- Concomitant use of transvaginal sonography and Doppler indices improve diagnosis of adenomyosis 2017
- Spontaneous conception following GnRHa and progestogen therapy in adenomyosis 2016
- Effectiveness of treatment for infertility using clinical investigation of laparoscopy cytoreductive surgery combined with gestrinone in adenomyosis 2016
- Benign endikasyonlarla yapılan histerektomi materyallerinde adenomiyozis sıklığı ile preoperatif endometrial biyopsi ve pelvik semptomlarla ilişkisi 2015
- An unexpected diagnosis of adenomyosis in the subfertile woman 2015
- Adenomyosis and female fertility: A critical review of the evidence 2012
- Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes 2012
- Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: Long-term follow-up in a series of nine patients 2012
- Infertility and Adenomyosis 2011
- Conservative surgical management for diffuse uterine adenomyosis 2009
- Histerektomi Materyallerinde Adenomyozis Sıklığının Araştırılması 2009
- Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? 2008
- Tratamiento de la adenomiosis 2007
- Traitement de l'adénomyose 2007
- Laparoscopic excision of uterine adenomyomas 2007
- Hormonal treatments for adenomyosis 2007
- Adénomyose 2006
- Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis 2006
- Adenomiosis 2006
- Spontaneous uterine rupture of a twin pregnancy after a laparoscopic adenomyomectomy: A case report 2006
- Medical and surgical management of adenomyosis 2006
- Therapeutic options for adenomyosis: a review 2006
- Adenomyosis: what is the impact on fertility? 2005
- Comments on Laparoscopic Excision of Myometrial Adenomyomas in Patients with Adenomyosis Uteri and Main Symptoms of Severe Dysmenorrhea and Hypermenorrhea 2004
- Modified Reduction Surgery for Adenomyosis 2003
- Uterine adenomyosis in the infertility clinic 2003
- Treatment of infertile women with adenomyosis with a conservative microsurgical technique and a gonadotropin-releasing hormone agonist 2000
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