# Advanced Management of Severe Adenomyosis in IVF: A Personalized Approach With Extended GnRH Agonist and Letrozole Therapy

## TL;DR

This case study shows that extended hormone suppression with GnRH agonist and letrozole improved pregnancy outcomes in a woman with severe adenomyosis undergoing IVF.

## Contribution

The study introduces a personalized protocol using prolonged GnRH agonist and letrozole for managing severe adenomyosis in IVF.

## Key findings

- Prolonged suppression reduced uterine size and improved endometrial preparation.
- A 5-month suppression cycle resulted in a successful ongoing pregnancy and healthy delivery.
- The approach may be beneficial for similar complex cases but requires further investigation.

## Abstract

The objective of this study is to evaluate the effectiveness of prolonged GnRH agonist (GnRH‐a) suppression combined with letrozole and intensive luteal phase support in a patient with severe adenomyosis undergoing frozen‐thawed embryo transfer (FET).

The study design was a case report.

The setting was a tertiary referral in vitro fertilization (IVF) clinic.

The subject was a 41‐year‐old woman with a history of primary infertility with severe adenomyosis and endometriosis. Her partner presented with nonobstructive azoospermia.

Following micro‐TESE, ovarian stimulation, and ICSI, the patient received prolonged combined GnRH‐a and letrozole suppression before two attempts of single euploid frozen embryo transfer (eFET).

The main outcome measure was pregnancy outcome.

The first eFET cycle with 3 months of suppression resulted in an early miscarriage at 7 weeks. In the second cycle, a prolonged 5‐month suppression led to a significant reduction of the uterine size, lower serum estradiol levels, and optimal endometrial preparation, achieving an ongoing pregnancy and delivery of a healthy baby at 36 weeks of gestation.

This case supports the potential benefit of extended GnRH‐a and letrozole suppression with intensive luteal phase support for patients with severe adenomyosis, suggesting that individualized protocols may be beneficial and warrant further investigation in similar complex cases.