Primary Infertility in a Unicornuate Uterus Complicated by Adenomyosis and Managed Conservatively with Levonorgestrel-Intrauterine System (LNG-IUS) and Cervical Cerclage: a Case Report

Nicole Angela  A. Domingo,; Regta  L. Pichay,

Primary Infertility in a Unicornuate Uterus Complicated by Adenomyosis and Managed Conservatively with Levonorgestrel-Intrauterine System (LNG-IUS) and Cervical Cerclage: a Case Report

Nicole Angela A. Domingo | Regta L. Pichay

Abstract:

A Adenomyosis, a benign infiltration of aberrant endometrial glands within the myometrium has traditionally been treated with hysterectomy as the gold standard. Over the last decade, the proper management for patients with adenomyosis has been a matter of contention, particularly in symptomatic women strongly desirous of pregnancy since both medical and surgical modalities exist to cater to primary infertility patients. In the Philippines, 1.2% of the population are diagnosed with Müllerian anomalies; and an undetermined incidence of these women are also affected by adenomyosis. Müllerian anomalies and adenomyosis are associated with lifelong primary infertility and as such, individualized treatment is necessary especially in the advent of uterine-preserving surgical techniques. This is a case of a 35-year old nulligravid diagnosed with a unicornuate uterus with adenomyosis who underwent laparoscopic surgery in 2018 for bilateral salpingectomy and removal of a functional non-communicating rudimentary horn, an endometriotic cyst, and a subserous myoma. She was treated with Dienogest pills post-operatively for 6 months which led to the resolution of adenomyosis as documented by normal findings on repeat transvaginal sonogram. Anti-Müllerian hormone was determined to be 0.04 ng/mL for which she was referred to a fertility center. 8 months later, she returned with profuse vaginal bleeding and re-growth of adenomyosis seen on transvaginal sonogram. This case report tackles the individualized treatment of a patient strongly desirous of pregnancy who is diagnosed with a Müllerian anomaly complicated by adenomyosis. The possibility of performing a uterine-preserving surgical technique is explored, along with the maximization of available medical modalities as an alternative.

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