Background: Adenomyosis is an emerging enigmatic uterine disease that negatively impacts women's fertility. Conservative treatments, including medical management, offer hope to preserve future fertility but remain challenging, especially in low-resource settings. Since 2019, at our center, infertile women diagnosed with symptomatic adenomyosis have been pre-treated with either a Levonorgestrel-Releasing Intrauterine System (LNG-IUS) or Dienogest based on physician preference. Following symptomatic relief, ovarian stimulation protocols were applied to optimize the chances of natural conception without assisted reproductive technologies (ART). This study aimed to compare fertility outcomes following ovarian stimulation in infertile women with symptomatic adenomyosis who had been pre-treated with LNG - IUS versus Dienogest.

Methods: This quasi-experimental study was conducted at Bangladesh Medical University (BMU), Dhaka, from January 2024 to December 2024. Infertile women with previously diagnosed symptomatic adenomyosis, symptomatically relieved by LNG-IUS or Dienogest, were enrolled. Following enrolment, LNG-IUS devices were removed and Dienogest was discontinued. Participants were divided into two groups: Group A (pre-treated with LNG - IUS) and Group B (pre-treated with Dienogest) and both underwent ovarian stimulation using oral ovulogens.

Results: Both groups were comparable in baseline socio demographic, biochemical and biophysical criteria. Ovulation and pregnancy rate in each cycle were higher in LNG-IUS group than Dienogest group though this difference was not statistically significant (p>0.05).

Limitations: The sample size of the study was relatively small which may limit the generalisability of the findings and the ability to detect smaller differences between the groups. Only three cycles of ovarian stimulation were applied due to restricted time frame which may not be sufficient to observe long term effects or outcomes of the treatments. It was conducted at a single centre which may limit the external validity of the findings.

Conclusions: This study of infertile women of symptomatic Adenomyosis pretreated with LNG-IUS and Dienogest showed statistically no significant difference regarding ovarian response and achieving pregnancy rates following ovarian stimulation. However Pre-treatment with LNG-IUS prior to ovarian stimulation may offer better fertility outcomes compared to Dienogest, though larger studies involving more cycles and multicenter collaboration are necessary to confirm these findings.

Nur Wa Bushra Jahan is an accomplished physician and academic with extensive experience in obstetrics, gynecology, and child health. She completed her MBBS from Dhaka Medical College in 2002, followed by FCPS certification from the Bangladesh College of Physicians & Surgeons in 2013. She further enhanced her professional expertise by obtaining the MRCOG (Primary) from the Royal College of Obstetricians and Gynaecologists, London, England. Currently serving as an Assistant Professor, she is dedicated to providing high-quality maternal and child healthcare while contributing to medical education and research in her field.