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

Hanom Husni Syam, David Halim, Marissa Tasya, Nicholas Adrianto
In: International Journal of Women's Health · 2026 · vol. Volume 18 , pp. 1–7 · doi:10.2147/ijwh.s609580 · PMID:42199947 · W7161639428
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⚙ AI-generated deep summary by claude@2026-06, 2026-06-15 ⓘ

This paper is a case report of a 41-year-old woman with advanced maternal age, primary infertility, posterior adenomyosis, surgically treated endometriosis, and male factor infertility who underwent IVF after laparoscopic excision of endometriosis. Using a prolonged GnRH agonist protocol with depot triptorelin for four weeks followed by controlled ovarian stimulation with recombinant FSH/LH and ICSI, the patient retrieved eight oocytes (100% fertilization) with two good-quality day-3 embryos transferred fresh and three blastocysts cryopreserved; serial β-hCG monitoring indicated early pregnancy and she was reported as 35+6 weeks with a viable singleton and unremarkable antenatal course. The authors note that this is a single-patient experience, and they call for prospective studies with more robust endpoints such as preimplantation genetic testing and cumulative live birth rate. This paper is centrally about endometriosis — it reports successful IVF/ongoing pregnancy using a prolonged GnRH agonist protocol in a patient with adenomyosis and concomitant endometriosis.

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Abstract

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.

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Condition tags

endometriosisadenomyosisinfertility

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

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