Comparison of the Efficacy of Oral Elagorelix Versus Leuprolide Depot: Optimizing Natural Conception in Women with Endometrioma

This retrospective cohort study compared oral elagorelix (200 mg twice daily for 3 months) versus monthly intramuscular leuprolide depot (3.75 mg) in 100 women with ovarian endometriomas (<3 cm), patent fallopian tubes, normal semen parameters, and both asymptomatic and symptomatic disease. The primary outcome was spontaneous conception within 12 months after treatment cessation, with secondary outcomes including adherence, symptom relief (especially dysmenorrhea), and endometrioma size reduction by transvaginal sonography. Spontaneous conception occurred in 36% with elagorelix versus 12.5% with leuprolide (p = 0.028), and compliance was higher with elagorelix (100% vs 20% lost to follow-up), along with earlier return of regular menstrual cycles. The paper’s main limitations include its retrospective design and potential for differential follow-up. This paper is centrally about endometriosis — it directly evaluates elagorelix versus leuprolide for fertility outcomes and cyst/symptom improvements in women with endometrioma.

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