P-324 Effectiveness of letrozole in symptomatic women with adenomyosis undergoing IVF: An overview of clinical features, sonographic characteristics, and reproductive outcome

Abstract Study question Is letrozole pre-treatment a cost-effective option in improving symptoms, sonographic features, and reproductive outcomes in women with adenomyosis, undergoing IVF treatment? Summary answer Only two months of low dose letrozole pre-treatment is as effective as GnRH-agonist in symptomatic adenomyosis while significantly reducing the cost of treatment. What is known already About 20%–25% of women undergoing IVF present with adenomyosis and many of them suffer from dysmenorrhea and menorrhagia. Adenomyosis is often underdiagnosed and neglected uterine pathology which has a major bearing on the quality of life and fertility. Since adenomyosis is an estrogen-dependent disorder, letrozole, an aromatase inhibitor (controls estrogen production) is reported to be effective in improving symptoms of adenomyosis similar to GnRH-agonist but its role as before treatment IVF is unclear. Although GnRH-agonist is an established and effective pre-treatment option, is expensive and comes with the concerns like menopausal symptoms, increased gonadotropin doses, and duration of stimulation. Study design, size, duration This longitudinal, randomized cohort study was conducted at a tertiary-care hospital during June-2019 and November-2021. 194 adenomyosis women with symptoms undergoing fresh-cycle IVF, were screened and 147 recruited. These women were resistant to OCPs/progestins for symptomatic relief. 72 patients were treated with letrozole and 75 with GnRH-agonist for 2 months, and changes in their sonographic features and symptoms were evaluated before and after treatment. Reproductive outcomes were also compared between the treatment groups after IVF. Participants/materials, setting, methods Adenomyosis was diagnosed on 2D-TVS according to MUSA criteria. Among them, 72 patients were treated with 2.5 mg letrozole (only thrice weekly instead of conventional 2.5mg/daily) and 75 women were treated with GnRH-agonist depot (3.6mg/month) for 2 months. Patients were evaluated before and after 2 months of treatment for improvements in dysmenorrhea (VAS score) and menorrhagia (PBAC score), and quantitative scoring of sonographic features. Reproductive outcomes were also compared after both treatment. Main results and the role of chance The majority of women had 3-4 sonographic criteria on TVS (median of 3), such as irregular or interrupted junctional zone (79.49%), asymmetrical thickening of the myometrium (71.15%), globular uterus (43.59%), and myometrial cys