Live birth after conservative surgery for severe adenomyosis following magnetic resonance imaging and gonadotropin-releasing hormone agonist therapy.

摘要

This is a report of a live birth after conservative surgery for severe adenomyosis following diagnosis by MRI and therapy with GnRH-a. A 33-year-old gravida 1 para 1 woman with a 5-year history of secondary infertility received a gonadotropin-releasing hormone agonist (GnRH-a), leuprolide acetate, for 16 weeks to control symptoms of severe adenomyosis and to treat infertility. However, severe dysmenorrhea recurred after the discontinuation of therapy. Because an elevated serum level of CA-125 and MRI findings suggested that she was experiencing a relapse of adenomyosis, GnRH-a therapy was re-instituted. After 24 weeks of the second therapy, her uterus decreased to normal size and an MRI revealed a localized low-signal-intensity myometrial mass with well-defined borders. We easily resected the localized lesion of adenomyosis using the same technique used to treat uterine leiomyoma. The patient became pregnant after 12 weeks of additional danazol therapy. A healthy male infant was delivered at term by cesarean section.