Targeted Management of Adenomyosis: Frozen Embryo Transfer Outcomes With GNRH-Agonist and Letrozole Therapy

Objective : To apply a combined protocol using GnRH agonists and letrozole for endometrial preparation in patients with severe adenomyosis undergoing frozen euploid single embryo transfer (eFET). Design : Case series. Setting : Tertiary referral in vitro fertilization (IVF) clinic. Patients : Three women with moderate and severe adenomyosis and histories of recurrent IVF failures and miscarriages underwent a combined protocol using GnRH agonists and letrozole and diagnostic hysteroscopy with saline instillation followed by hormonal replacement therapy(HRT) for eFET. Main Outcomes Measures: Implantation rates and ongoing pregnancy outcomes. Results : Our three cases resulted in deliveries at 36 ,38 and 40 weeks. Conclusions : Adenomyosis-related infertility remains a challenge. This case series supports the potential efficacy of hormonal suppression by combining GnRH-a, aromatase inhibitors and diagnostic hysteroscopy with saline irrigation prior to the endometrial preparation for eFET in patients with adenomyosis. This protocol offers a promising alternative for cases unresponsive to standard treatments, although further research is warranted to refine guidelines on treatment duration and dosage.