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Medical treatment before in-vitro fertilization in patients with adenomyosis: a systematic review and meta-analysis

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Abstract

The objective of this study is to evaluate if medical treatment before assisted reproductive technology (ART) improves the results in infertile patients with adenomyosis. A literature search was performed with EMBASE, PubMed, and Cochrane. The primary outcome was clinical pregnancy rate (CPR). Secondary outcomes were live birth rate (LBR) per cycle and miscarriage rate (MR) after ART with or without medical pretreatment. Additionally, a comparison was made between women undergoing medical pretreatment before frozen embryo transfer (FET) and those who underwent FET alone, including any type of endometrial preparation. Ten studies were included. The present meta-analysis supports the use of long-term GnRH agonist therapy in patients with adenomyosis, which enhances the CPR (odds ratio (OR) 1.49, 95% CI 1.15 to 1.92) in IVF/ICSI with fresh ET, while the comparison in women undergoing FET cycles did not reach statistical significance (OR 1.34 95% CI 0.70–2.55). Pretreatment with GnRH agonist did not demonstrate a benefit on the LBR and MR per cycle in IVF/ICSI with fresh ET in comparison to standard ovarian stimulation protocols. Similar results were observed in the setting of FET, failing to indicate a superiority of GnRH agonist pretreatment over standard FET protocols for LBR and MR. In conclusion, GnRH agonist pretreatment before ART carries a potential benefit in improving outcomes in terms of higher CPR, but there is no significant impact on LBR and MR. Pretreatment with GnRH agonists could be adopted as a possible alternative ART protocol in selected patients with adenomyosis and infertility.

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Data Availability

All data involved in this study will be made available by the corresponding author upon request.

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Funding

This research received no external funding.

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Authors and Affiliations

  1. Department of Maternal and Child Health and Urology, Sapienza University, Viale Regina Elena, 324 - 00161, Rome, Italy

    Giulia Galati, Carlotta Olivieri, Martina Cosentino, Ilham Azenkoud, Giuseppe Rizzo & Ludovico Muzii

  2. Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy

    Sara Cugini

  3. Department of Gynecology, San Carlo Nancy Hospital, Rome, Italy

    Giuseppe Sorrenti

Authors
  1. Giulia Galati
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  2. Carlotta Olivieri
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  3. Martina Cosentino
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  4. Ilham Azenkoud
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  5. Sara Cugini
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  6. Giuseppe Sorrenti
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  7. Giuseppe Rizzo
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  8. Ludovico Muzii
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Contributions

L.M. conceived this systematic review and meta-analysis in consultation with G.G, G.R. and G.S. C.O., M.C., I.A. and S.C. have collected data and conducted the systematic review. G.G. carried out the statistical analyses. L.M., and G.G. wrote the first draft of the manuscript. L.M., G.G., G.R., G.S., C.O., M.C., I.A. and S.C. provided criticism of the manuscript. All authors reviewed the manuscript and approved the final version for submission.

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Correspondence to Giulia Galati.

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Galati, G., Olivieri, C., Cosentino, M. et al. Medical treatment before in-vitro fertilization in patients with adenomyosis: a systematic review and meta-analysis. J Assist Reprod Genet 42, 381–388 (2025). https://doi.org/10.1007/s10815-024-03323-2

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