Research question

How does use of a levonorgestrel-releasing intrauterine system (LNG-IUS) in infertile women with endometrial hyperplasia without atypia affect endometrial hyperplasia regression and pregnancy rates compared with oral medroxyprogesterone acetate (MPA)?

Design

This prospective cohort study included 215 infertile women with an indication for assisted reproductive technology (ART) and a diagnosis of endometrial hyperplasia without atypia. Endometrial hyperplasia was diagnosed by hysteroscopic endometrial biopsy. At the time of first- and second-line treatment, patients were offered therapy with either oral MPA 10 mg daily or LNG-IUS. Follow-up biopsies were scheduled after 90 days’ treatment. After endometrial hyperplasia regression, patients were admitted to IVF/intracytoplasmic sperm injection (ICSI) cycles.

Results

Baseline characteristics and confounders including age at diagnosis, body mass index and duration of infertility did not differ between LNG-IUS users and control participants and were accounted for using propensity score weighting. Endometrial hyperplasia regression rate at first follow-up was higher in the LNG-IUS group than the oral progestins group (28/28, 100% and 110/187, 58.8%; P < 0.001), while that after second-line treatment was comparable between the two groups (89/91, 97.8% and 122/124, 98.4%; P = 0.22). Clinical pregnancy rate, miscarriage rate and cumulative live birth rate following ART in patients ever receiving LNG-IUS were similar to those of patients receiving only MPA (34% versus 39.5%, 22.6% versus 34.7% and 26.4% versus 25.8%).

Conclusion

Endometrial hyperplasia regression is greater in women receiving LNG-IUS compared with oral MPA, while live birth rates following ART are comparable between the two groups. The use of LNG-IUS does not jeopardize the chances of pregnancy in women seeking fertility treatment.

中文翻译：

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左炔诺孕酮宫内缓释系统对比口服醋酸甲羟孕酮治疗无异型性子宫内膜增生的不孕妇女

研究问题

与口服醋酸甲羟孕酮 (MPA) 相比，在没有异型性的子宫内膜增生的不孕妇女中使用左炔诺孕酮宫内释放系统 (LNG-IUS) 对子宫内膜增生消退和妊娠率有何影响？

设计

这项前瞻性队列研究包括 215 名具有辅助生殖技术 (ART) 适应症且诊断为子宫内膜增生而无异型性的不孕妇女。子宫内膜增生通过宫腔镜子宫内膜活检诊断。在一线和二线治疗时，为患者提供每日口服 MPA 10 mg 或 LNG-IUS 治疗。后续活检安排在治疗 90 天后进行。子宫内膜增生消退后，患者进入体外受精/胞浆内精子注射 (ICSI) 周期。

结果

基线特征和混杂因素（包括诊断年龄、体重指数和不孕持续时间）在 LNG-IUS 用户和对照组参与者之间没有差异，并且使用倾向评分加权进行了解释。LNG-IUS组首次随访子宫内膜增生消退率高于口服孕激素组（28/28, 100%和110/187, 58.8%; P  < 0.001），而二线治疗后为两组之间具有可比性（89/91, 97.8% 和 122/124, 98.4%；P  = 0.22）。接受过 LNG-IUS 的患者 ART 后的临床妊娠率、流产率和累积活产率与仅接受 MPA 的患者相似（34% 对 39.5%、22.6% 对 34.7% 和 26.4% 对 25.8%）。

结论

与口服 MPA 相比，接受 LNG-IUS 的女性的子宫内膜增生消退更大，而 ART 后的活产率在两组之间具有可比性。使用 LNG-IUS 不会危及寻求生育治疗的女性的怀孕机会。