Management of adenomyosis in subfertile women and pregnancy outcome

To assess the outcome of treatment with only gonadotropin releasing hormone agonists [Gn-RHa] versus combined conservative surgery and Gn-RHa therapy in the management of sub-fertile patients with symptomatic uterine adenomyosis. A retrospective study of the two treatment modalities allocated to 40 sub-fertile patients with pathology-proven adenomyosis over a period of eight years was undertaken at the Obstetrics and Gynecology department, King Fahad Hospital, Dammam University, Saudi Arabia. Twenty-two patients [Group A] were treated with Gn-RHa alone, and 18 patients [Group B] received combined conservative surgery with Gn-RHa therapy. After completion of six courses of Gn-RHa injections, there was a 3-year follow up period for all patients. Treatment outcome included relief of symptoms, pregnancy rate and successful deliveries, which were compared between the two groups. The patients in group A were younger in age, had lower CA-125 levels and shorter infertile years than Group B. Three [13.6%] spontaneous pregnancies resulted upto 18 months of stopping Gn-RHa in group A, while 8 [44.4%] pregnancies resulted upto 36 months in group B patients, which was statistically significant [p=0.0393]. Term delivery occurred normally in one [4.5%] Group A patient, while 6 [33.3%] patients in Group B had cesarean section at term [p=0.0328]. Combined conservative surgery and Gn-RHa may provide effective symptom relief, better reproductive performance in subfertile patients with uterine adenomyosis and longer period of pregnancy prospects after treatment than patients who recieved Gn-RHa alone. Due to the nature of this study, a well conducted randomized trial is needed in the future to assess the benefits of the two treatment modalities

Successful consecutive pregnancies in alternate horns of a uterus didelphys

Uterus didelphys bicollis is often asymptomatic and remains undiagnosed until the patient marries. This patient presented with dyspareunia after marriage and a vaginal septum was discovered. During excission of the septum the double uterus and cervix was discovered, later confirmed by hysterosalpingography. This patient had successful consecutive pregnancies in alternate horns of the uterus which is described in this report