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Jul 12, 2023Keywords:
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Main Article Content
Improvement of ovarian function and fertility in patients with endometriosis after combination therapy with levonorgestrel-releasing intrauterine system plus gonadotropin-releasing hormone agonist
Abstract
Purpose: To evaluate the therapeutic efficacy of gonadotropin-releasing hormone agonist (GnRHa) plus levonorgestrel-releasing intrauterine system (LNG-IUS) for moderate and severe endometriosis (EMS).
Methods: 94 patients with EMS were randomized into experimental and control groups. Patients in the experimental group (EG) received LNG-IUS + GnRHa while those in the control group (CG) received GnRHa. Pre- and post-treatment estradiol (E2), folliclestimulating hormone (FSH), luteinizing hormone (LH), interleukin (IL)-2, IL-4, and interferon-γ (INF-γ) levels in serum were measured, and alterations in antral follicle count (AFC), ovarian stroma (OS) and peak systolic velocity (PSV) were observed using an ultrasonic tester. Patients were followed up for one-year during which the severity of dysmenorrhea was determined with the Visual Analogue Scale (VAS), and the clinical efficacy was evaluated at the last follow-up while the recurrence of EMS was counted.
Results: EG patients had lower FSH, E2, LH and IL-2 levels than CG patients after treatment, with higher AFC, PSV, IL-4 and INF-γ (p<0.05). The prognostic follow-up showed a continuous decrease in VAS in both groups, with a lower score among EG patients (p<0.05). No statistical difference was identified in the recurrence rate of EMS between EG and CG patients (p>0.05) even though the overall response rate was higher among EG patients (p<0.05).
Conclusion: LNG-IUS + GnRHa has better, stable and long-term efficacy against moderate and severe EMS, and higher efficacy in improving patients’ ovarian function.
