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Background <p>Adenomyosis negatively impacts fertility treatment outcomes by lowering clinical pregnancy rates, reducing live birth rates, and increasing miscarriage rates following <i>in&#xa0;vitro</i> fertilization. Hormonal suppression therapy has emerged as a preferred treatment for patients with adenomyosis, particularly before endometrial preparation for frozen-thawed embryo transfer; however, the combination therapy for individualized patients can improve the outcomes. Here we present three cases in wherein we applied a combined protocol using GnRH agonists and letrozole for endometrial preparation in patients with severe adenomyosis undergoing euploid frozen embryo transfer with a single embryo.</p> Case presentation <p>Three women with Arabian (Emirati) ethnicity aged 31–32 year old with moderate and severe adenomyosis and histories of recurrent <i>in&#xa0;vitro</i> fertilization failures and miscarriages underwent a combined protocol using GnRH agonists and letrozole and diagnostic hysteroscopy with saline instillation followed by hormonal replacement therapy for euploid frozen embryo transfer. Our three cases resulted in deliveries at 36, 38, and 40 weeks.</p> Conclusions <p> Adenomyosis-related infertility remains a challenge. This case series supports the potential efficacy of hormonal suppression by combining GnRH agonists, aromatase inhibitors, and diagnostic hysteroscopy with saline irrigation prior to the endometrial preparation for euploid frozen embryo transfer 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.</p>

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Targeted management of adenomyosis: frozen embryo transfer outcomes with GnRH-agonist and letrozole therapy: a case series

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月9日

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  • Maryam Farid Mojtahedi,
  • Laura Melado,
  • Jonalyn Edades,
  • Barbara Lawrenz,
  • Human M. Fatemi

摘要

Background

Adenomyosis negatively impacts fertility treatment outcomes by lowering clinical pregnancy rates, reducing live birth rates, and increasing miscarriage rates following in vitro fertilization. Hormonal suppression therapy has emerged as a preferred treatment for patients with adenomyosis, particularly before endometrial preparation for frozen-thawed embryo transfer; however, the combination therapy for individualized patients can improve the outcomes. Here we present three cases in wherein we applied a combined protocol using GnRH agonists and letrozole for endometrial preparation in patients with severe adenomyosis undergoing euploid frozen embryo transfer with a single embryo.

Case presentation

Three women with Arabian (Emirati) ethnicity aged 31–32 year old with moderate and severe adenomyosis and histories of recurrent in vitro fertilization failures and miscarriages underwent a combined protocol using GnRH agonists and letrozole and diagnostic hysteroscopy with saline instillation followed by hormonal replacement therapy for euploid frozen embryo transfer. 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 agonists, aromatase inhibitors, and diagnostic hysteroscopy with saline irrigation prior to the endometrial preparation for euploid frozen embryo transfer 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.