Impact of Ultra-long Versus Long Down-regulation Protocol on IVF/ICSI in Adenomyosis
Status:
Not yet recruiting
Trial end date:
2025-01-01
Target enrollment:
Participant gender:
Summary
Adenomyosis is a benign condition defined as the invasion of ectopic endometrium into the
myometrium, resulting in smooth muscle hyperplasia and endometrial inflammation, commonly
associated with endometriosis and uterine fibroids.
Heterogeneity among studies regarding diagnostic criteria and therapeutic management has fed
the debate surrounding the impact of adenomyosis on assisted reproductive therapy outcomes.
Nevertheless, recent data support that adenomyosis impairs reproductive outcomes associated
with in vitro fertilization (IVF). According to several experimental data, prolonged exposure
to gonadotropin releasing hormone (GnRH) agonists may overcome part of the detrimental impact
of adenomyosis on fertility outcome. Overall, GnRH agonist treatment resulted in decreased
local production of cytochrome P450 aromatase, decreased intrauterine concentration of free
radicals and reduced inflammatory response and angiogenesis in endometrium, myometrium and
adenomyosis lesions. At the same time, GnRH agonists affect neither endometrial capacity to
support invasion nor invasive potential of the blastocyst in the early stages of
implantation.
For IVF, 2 main protocols based on GnRH agonist pituitary down-regulation are available:
- the long protocol involving a 15 days pituitary down-regulation;
- the ultra-long protocol involving a 3 months pituitary down-regulation. Most studies
using ultra-long protocol reported similar IVF outcomes in adenomyosis patients and
control groups. Conversely, studies involving long or GnRH antagonist protocols
demonstrated a significant reduction in clinical and ongoing pregnancy rates in
adenomyosis patients compared to control subjects. Thus supporting that ultra-long
protocol may be beneficial to improve IVF outcomes in the setting of adenomyosis.This is
what investigators would like to demonstrate in this study