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Introduction <p>Endometrioma, even when asymptomatic, may adversely affect reproductive outcomes by interfering with folliculogenesis, oocyte quality and the pelvic microenvironment. Suppression of endometriotic activity with gonadotropin-releasing hormone (GnRH) analogue has been utilized to improve the likelihood of spontaneous conception. Recently, oral GnRH antagonists such as elagorelix have emerged as less invasive alternatives to injectable depot medications. This study aims to compare the efficacy of oral elagorelix versus intramuscular Leuprolide Depot in facilitating spontaneous conception, reducing endometrioma size, alleviating symptoms and improving patient compliance.</p> Methods <p>A retrospective cohort study was conducted on 100 women with both asymptomatic and symptomatic ovarian endometriomas (&lt; 3&#xa0;cm), patent fallopian tubes and partners with normal semen parameters. Group A (n = 50) received oral elagorelix 200&#xa0;mg twice daily for 3&#xa0;months, while Group B (n = 50) received Leuprolide Depot 3.75&#xa0;mg monthly for the same duration. Patients were monitored monthly and followed for 12-months post-treatment for spontaneous conception, symptom relief, cyst size reduction and compliance. Primary outcome was defined as spontaneous conception rate within 12&#xa0;months of treatment cessation. Secondary outcomes involved patient compliance (treatment adherence), symptom improvement (notably dysmenorrhea) and reduction in endometrioma size on transvaginal sonography.</p> Results <p>Baseline demographics and reproductive characteristics were comparable between the elagorelix and leuprolide groups. Spontaneous conception occurred in 36% of the elagorelix group compared to 12.5% in the Leuprolide group (<i>p</i> = 0.028). Compliance was 100% in the elagorelix group, while 20% of patients in the Leuprolide group were lost to follow-up. Both treatments resulted in symptomatic relief and cyst size reduction; however, elagorelix demonstrated more pronounced benefits in both domains. Additionally, patients in the elagorelix group reported earlier return of regular menstrual cycles (2.85&#xa0;months vs 4.23&#xa0;months in leuprolide arm), which may have contributed to the higher conception rates observed. The greater ease of administration and reduced need for clinical visits likely played a key role in enhancing adherence among elagorelix users.</p> Conclusion <p>Oral elagorelix is superior to Leuprolide Depot in enhancing spontaneous conception rates, reducing endometrioma size, relieving symptoms and ensuring better treatment adherence. Given its ease of administration and quicker return to ovulatory function, elagorelix may be the preferred option in fertility-focused management of asymptomatic endometriomas.</p>

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Comparison of the Efficacy of Oral Elagorelix Versus Leuprolide Depot: Optimizing Natural Conception in Women with Endometrioma

  • 期刊论文

  • 发表日期：

    2026年4月18日

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  • Ashish Kale,
  • Ashwini Kale,
  • Avir Sarkar,
  • Amiya Das,
  • Suman Sandeep Samal

摘要

Introduction

Endometrioma, even when asymptomatic, may adversely affect reproductive outcomes by interfering with folliculogenesis, oocyte quality and the pelvic microenvironment. Suppression of endometriotic activity with gonadotropin-releasing hormone (GnRH) analogue has been utilized to improve the likelihood of spontaneous conception. Recently, oral GnRH antagonists such as elagorelix have emerged as less invasive alternatives to injectable depot medications. This study aims to compare the efficacy of oral elagorelix versus intramuscular Leuprolide Depot in facilitating spontaneous conception, reducing endometrioma size, alleviating symptoms and improving patient compliance.

Methods

A retrospective cohort study was conducted on 100 women with both asymptomatic and symptomatic ovarian endometriomas (< 3 cm), patent fallopian tubes and partners with normal semen parameters. Group A (n = 50) received oral elagorelix 200 mg twice daily for 3 months, while Group B (n = 50) received Leuprolide Depot 3.75 mg monthly for the same duration. Patients were monitored monthly and followed for 12-months post-treatment for spontaneous conception, symptom relief, cyst size reduction and compliance. Primary outcome was defined as spontaneous conception rate within 12 months of treatment cessation. Secondary outcomes involved patient compliance (treatment adherence), symptom improvement (notably dysmenorrhea) and reduction in endometrioma size on transvaginal sonography.

Results

Baseline demographics and reproductive characteristics were comparable between the elagorelix and leuprolide groups. Spontaneous conception occurred in 36% of the elagorelix group compared to 12.5% in the Leuprolide group (p = 0.028). Compliance was 100% in the elagorelix group, while 20% of patients in the Leuprolide group were lost to follow-up. Both treatments resulted in symptomatic relief and cyst size reduction; however, elagorelix demonstrated more pronounced benefits in both domains. Additionally, patients in the elagorelix group reported earlier return of regular menstrual cycles (2.85 months vs 4.23 months in leuprolide arm), which may have contributed to the higher conception rates observed. The greater ease of administration and reduced need for clinical visits likely played a key role in enhancing adherence among elagorelix users.

Conclusion

Oral elagorelix is superior to Leuprolide Depot in enhancing spontaneous conception rates, reducing endometrioma size, relieving symptoms and ensuring better treatment adherence. Given its ease of administration and quicker return to ovulatory function, elagorelix may be the preferred option in fertility-focused management of asymptomatic endometriomas.