Turning Challenges into Success: Successful Pregnancy in Advanced Maternal Age with Adenomyosis Using Prolonged GnRH Agonist Protocol: A Case Report

Hanom Husni Syam,1 David Halim,1 Marissa Tasya,1 Nicholas Adrianto2 1Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Padjadjaran University, Dr Hasan Sadikin General Hospital, Bandung, West Java, Indonesia; 2School of Medicine and Health Sciences, Atma Jaya Catholic University of Indonesia, North Jakarta, Daerah Khusus Ibukota Jakarta, IndonesiaCorrespondence: Hanom Husni Syam, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Padjadjaran University, Dr Hasan Sadikin General Hospital, Bandung, West Java, Indonesia, Email [email protected]: Advanced maternal age (AMA) is a major challenge in reproductive medicine, compounded by coexisting conditions such as adenomyosis and endometriosis, which impair oocyte competence and endometrial receptivity. Prolonged gonadotropin-releasing hormone agonist (GnRHa) protocols have been proposed to improve in vitro fertilization-embryo transfer (IVF-ET) outcomes. We report the case of a 41-year-old Indonesian woman with 13 years of primary infertility, AMA, adenomyosis, endometriosis, and male factor infertility. Following laparoscopic excision of endometriosis, she underwent a prolonged GnRH agonist protocol with depot triptorelin, followed by controlled ovarian stimulation using recombinant FSH and LH. Despite an initially modest response, eight oocytes were retrieved and all fertilized via ICSI. Two good-quality day-3 embryos were transferred fresh, and three blastocysts were cryopreserved. Intensive luteal support with hCG, progesterone, dydrogesterone, and estradiol was administered. Serial β-hCG confirmed early pregnancy, and at the time of reporting, she is 35+6 weeks pregnant with a viable singleton and unremarkable antenatal course. This case demonstrates that prolonged GnRHa protocols may offer favorable outcomes in women with AMA and multiple adverse prognostic factors, including adenomyosis, endometriosis, and male factor infertility. While encouraging, such results require cautious interpretation, and further prospective studies incorporating preimplantation genetic testing and cumulative live birth rate are needed to clarify their broader applicability.Keywords: infertility, fertilization in vitro, gonadotropin-releasing hormone, adenomyosis