Table 1_Effect of extended hormonal suppression in patients with adenomyosis undergoing embryo transfer.docx

Adenomyosis is an estrogen-dependent uterine disorder increasingly recognized as a major cause of infertility and adverse obstetric outcomes, yet optimal medical preparation before embryo transfer (ET) remains uncertain. Adenomyotic lesions create a hyperestrogenic, inflammatory, and architecturally distorted uterine environment that may impair endometrial receptivity and increase miscarriage risk, compromising assisted reproductive technology (ART) success. This review summarizes current evidence on extended hormonal suppression in patients with adenomyosis undergoing in vitro fertilization and ET. We examine the rationale, protocols, and reproductive outcomes of ultra-long gonadotropin-releasing hormone agonist (GnRHa) regimens, intensified suppression with GnRHa plus aromatase inhibitors, levonorgestrel-releasing intrauterine systems, oral dienogest, and continuous combined oral contraceptives. Available data suggest that prolonged GnRHa pretreatment, particularly in freeze-all strategies with frozen ET, may improve implantation and reduce miscarriage, with additional benefit from deeper suppression in selected severe cases. Progestin-based approaches appear promising but remain less well studied, while combined oral contraceptives mainly provide symptom control. The review highlights the heterogeneity and methodological limitations of existing studies and underscores the need for well-designed trials to define the optimal regimen, duration, and patient selection criteria for extended hormonal suppression before ET in women with adenomyosis.

子宫腺肌症 (Adenomyosis) 是一种雌激素依赖性子宫疾病，如今愈发被认定为不孕症与不良妊娠结局的重要诱因，但胚胎移植 (embryo transfer, ET) 前的最优药物预处理方案仍未明确。腺肌症病灶会构建出高雌激素状态、伴炎症反应且结构紊乱的子宫微环境，可损害子宫内膜容受性并升高流产风险，进而削弱辅助生殖技术 (assisted reproductive technology, ART) 的成功率。本综述总结了当前针对接受体外受精-胚胎移植 (in vitro fertilization and ET) 的子宫腺肌症患者实施延长激素抑制治疗的相关证据。我们探讨了超长疗程促性腺激素释放激素激动剂 (gonadotropin-releasing hormone agonist, GnRHa) 方案、联用GnRHa与芳香化酶抑制剂 (aromatase inhibitors) 以强化抑制效果、左炔诺孕酮宫内缓释系统 (levonorgestrel-releasing intrauterine systems)、口服地诺孕素 (dienogest) 以及连续复方口服避孕药 (continuous combined oral contraceptives) 的治疗原理、给药方案与生殖结局。现有数据显示，延长GnRHa预处理时长，尤其是配合全胚冷冻策略 (freeze-all strategies) 实施冷冻胚胎移植 (frozen ET) 时，或可提升着床率并降低流产风险，针对部分重症病例采用更强效的抑制治疗还可带来额外获益。基于孕激素的治疗方案颇具前景，但相关研究仍较为匮乏；而复方口服避孕药主要用于缓解临床症状。本综述指出了现有研究的异质性与方法学局限性，并强调亟需开展设计严谨的临床试验，以明确子宫腺肌症患者胚胎移植前延长激素抑制治疗的最优方案、疗程时长与患者筛选标准。