Nonsteroidal anti-inflammatory drugs for assisted reproductive technology

Current Medical Therapy for Adenomyosis: From Bench to Bedside

Adenomyosis, characterized by the growth of endometrial tissue within the uterine wall, poses significant challenges in treatment. The literature primarily focuses on managing abnormal uterine bleeding (AUB) and dysmenorrhea, the main symptoms of adenomyosis. Nonsteroidal anti-inflammatory drugs (NSAIDs) and tranexamic acid provide limited support for mild symptoms or symptom re-exacerbation during hormone therapy. The levonorgestrel-releasing intrauterine system (LNG-IUS) is commonly employed in adenomyosis management, showing promise in symptom improvement and reducing uterine size, despite the lack of standardized guidelines. Dienogest (DNG) also exhibits potential benefits, but limited evidence hinders treatment recommendations. Danazol, while effective, is limited by androgenic side effects. Combined oral contraceptives (COCs) may be less effective than progestins but can be considered for contraception in young patients. Gonadotropin-releasing hormone (GnRH) agonists effectively manage symptoms but induce menopausal symptoms with prolonged use. GnRH antagonists are a recent option requiring further investigation. Aromatase inhibitors (AIs) show promise in alleviating AUB and pelvic pain, but their safety necessitates exploration and limited use within trials for refractory patients. This review highlights the complexity of diagnosing adenomyosis, its coexistence with endometriosis and uterine leiomyomas, and its impact on fertility and quality of life, complicating treatment decisions. It emphasizes the need for research on guidelines for medical management, fertility outcomes, long-term effects of therapies, and exploration of new investigational targets. Future research should optimize therapeutic strategies, expand our understanding of adenomyosis and its management, and establish evidence-based guidelines to improve patient outcomes and quality of life.

Influence of a Single Dose of Meloxicam Administrated during Canine Estrus on Progesterone Concentration and Fertility-A Clinical Case Study

This case report presents an observation of the influence of meloxicam administration, during the periovulatory phase, on corpora lutea function in the domestic dog (Canis familiaris). A 2 year old female German Shepherd dog, with a level of progesterone suggestive of the periovulatory period (5.97 ng/mL), received a single subcutaneous injection of meloxicam (0.2 mg/kg body weight). In this female, subsequent evaluation to detect the optimal time for mating revealed a strong decrease in P4 (2.77 ng/mL), although it increased to 13.98 ng/mL within the following three days. The same female conceived and delivered a litter of the same size as in a subsequent cycle where meloxicam was not administered. The use of NSAID (nonsteroidal anti-inflammatory drugs), and particularly meloxicam, as a COX-2 inhibitor that influences the production of prostaglandins has been reported as being potentially harmful for ovulation and pregnancy in various species, including humans. In dogs, the secretion of prostaglandin E (PGE) is thought to be important for ovulation and the formation of the corpora lutea, the only source of P4, which is required for pregnancy maintenance. Although previous case reports have indicated an influence of meloxicam administration on CL function in domestic dogs, here, the decreased progesterone level observed directly after a single dose of meloxicam was only temporary, with no negative impact on fertility. Based on our observations, further studies related to the influence of the timing of meloxicam administration on ovarian cycle advancement, as well as the influence of duration of treatment, dosage, and route of administration on progesterone levels, as an indicator of CL function, are required.

Adenomyosis and Infertility-Review of Medical and Surgical Approaches

The aim of this review is to clarify the relative association between adenomyosis and infertility and the possible treatment for an infertile patient. Although adenomyosis is detected more often in women of late reproductive age, its influence on pregnancy rates is important, especially considering the tendency to delay pregnancy among women in developed countries. In this article, we present a critical analysis of the literature data concerning the impact of adenomyosis on fertility. The possible effects of treatment on the pregnancy rate will also be discussed. We conducted a literature search; publications from Pubmed, Embase and Cochrane databases published from 1982 to 2019 were retrieved using terms ’adenomyosis and infertility’ and ’adenomyosis and pregnancy outcomes’, extensively studied in the aspects of diagnosis, pathogenesis of infertility and possible treatment methods. Molecular studies have given deep insight into the pathogenesis of adenomyosis in the recent few years, but there is a huge discrepancy between in vitro studies and praxis. Oral contraceptive pills, anti-prostaglandins, oral or parenteral progestins, danazol and gonadotrophin-releasing hormone (GnRH) analogues have all been used to control menstrual pain and menorrhagia in women with adenomyosis, but they temporarily suppress the menstrual cycle. Additionally, endometrial ablation and hysterectomy used to alleviate pain caused by adenomyosis exclude pregnancy planning. The development of imaging techniques—ultrasound and MRI—enables the diagnosis of adenomyosis with very high accuracy nowadays, but the methods of treatment mentioned above have not given satisfactory results in women planning pregnancy. For these patients, the high-intensity-focused ultrasound method (HIFU) and combined treatment before assisted reproductive techniques can prove beneficial in adenomyosis patients.