How to improve IVF results in adenomyosis?

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 =- Dienogest has been used as a contraceptive with estrogen for years. As only a monotherapy- as progesterone its use is new. Irregular bleeding is a side effect.

Eficacy”\?

Adenomyosis & Pre Transfer use of Dienogest::-Diengest  is definitely effective in dysmenorrhoea associated with endometriosis/ adenomyosis.We have tried for Adenomyosis, rather, now it is the first line drug for me in Adenomyosis related implantation failure. 6 months to even an year and then plan ET in HRT or even natural cycle. It is working, although it cannot be generalised. Cases has to be selected.

 Dienogest gives good results in 50 % cases of endometriosis. In the other 50 % it does nt work at all. So no harm in trying. Cabergolin is effective or not in cases of endometriosis

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 Dienogest has helped some  patients with endometriosis e.g. 2-3 cms cysts have disappear with good pain relief. But there are equal number where it didn't help,

Indications :-1) Chocolate Cyst :- Dienogest is found particularly to be useful is pts who do not want surgery. There is no need of concomitant GNRH. But limitation is that D is not useful for fibroid 2) Dysmenorrhea: good results in dysmenorrhea and concomitantly cyst size decrease only  to some extent but not completely regresses  but irregular spotting is one problem commonly noticed in a woman who had Dysemen now bothered with irreg vaginal bleeding  noticed definitely with dienogest.

What about Bilateral endometriomas of  5-cm :-One can put women with  of bilateral endometriomas of  5cm with advise for  surgery  if she does not conceive by 6 months after D If one  put her on Dienogest surgery can be avoided. And preg can ensue soon  after stoppage of dienogest.

What about Bladder  endometriomas ?-  One can prescribe, In fact this the  most choiced drug in U bladder endo  as for reason best known to us we are unable to operate on bladder.

Dose of Dienogest :- They recommend minimum  2 mg od but can be given up to 10 mg

Duration of therapy:-Most of us prescribe for  4 months and quite often after stoppage of  dienogest women with   moderate sized cho cyst not only can become preg but  Usg is normal with no evidence of Cho cyst. It is such an wonderful drug. Ovaries can hopefully reduce in size . May be given for 6 months.

Side effects :- 1)  irregular bleeding with dienogest, 2) fair number will develop Amenorrhea.

What about Myoma or say Adenomyosis & or Myoma:- fourth generation progesterone Dienogest is being used with great success, it is also being used when there is combined  endometriosis and fibroid though Ulipristal and Mifepristone are better choices