[Gonadotropin releasing hormone agonists in the treatment of adenomyosis with infertility]

OBJECTIVE: To Study the role of gonadotropin releasing hormone agonists (GnRH-alpha) in the treatment of adenomyosis with infertility. METHODS: Adenomyosis was diagnosed under lapososcopy in 4 infertile cases. Meanwhile coexsting endometriosis, pelvic adhesion and adenomyoma were treated by surgery and endocoagulator in 4 and 2 cases respectively. GnRH-alpha (triptorelin or goserelin) therapy was given for six months before laparoscopic surgery in 1 case and after laparoscopic surgery in 3 cases. Their fecundity outcome were followed-up after cessation of GnRH-alpha treatment. RESULTS: All cases became amenorrheic during GnRH-alpha therapy. The enlarged uteri all decreased to normal or near normal size. Menstruation returned in 80-90 days after cessation of treatment. Three cases conceived within four menstrual periods. One of them resulted in the birth of a healthy 3 150 g male at 38 weeks gestation by cesarean section. The second pregnancy resulting after adenomyomectomy was terminated by emergent cesarean section at 30 weeks gestation because of threatened rupture of uterus. The third is now normal at 28 weeks pregnancy. The fourth has had 2 menstrual periods and is still being followed up. CONCLUSION: (1) GnRH-alpha thus used is efficient in reducing the adenomyotic uterine size, and may facilitate fertility. (2) For ademyomata associated with infertility, GnRH-alpha therapy may avoid the risk of rupture of uterus which may occur after adenomyomectomy pregnancy. (3) For infertility, GnRH-alpha treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases.