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Adenomyosis and infertility

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Journal of Assisted Reproduction and Genetics Aims and scope Submit manuscript

Abstract

Purpose

Adenomyosis is a poorly understood entity with no unified treatment protocol. It has been thought to only affect the quality of life of older women, but growing evidence is highlighting the increased frequency of adenomyosis in younger patients and its possible effects on fertility outcomes. This can have a great impact on how clinicians screen, diagnose, and treat this condition. The aim of this review is to explore the relationship between adenomyosis and infertility.

Methods

A literature search of the keywords “adenomyosis”, “infertility”, “pregnancy” and “fertility” was conducted using the PubMed and Medline search engines. The articles selected were observational, systematic reviews, meta-analyses, and randomized controlled trials. The search was limited to English, abstracts were screened, and articles were selected.

Results

The literature reports lower clinical pregnancy rates, lower live birth rates, higher miscarriage rates, and higher odds of adverse obstetric outcomes in patients with adenomyosis. Treatment seems to be associated with higher pregnancy rates and live births rates.

Conclusion

An association between adenomyosis and infertility seems to exist, and treatment could lead to improved fertility outcomes.

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References

  1. Bird CC, McElin TW, Manalo-Estrella P. The elusive adenomyosis of the uterus–revisited. Am J Obstet Gynecol. 1972;112(5):583–93.

    Article  CAS  Google Scholar 

  2. García-Solares J, et al. Pathogenesis of uterine adenomyosis: invagination or metaplasia? Fertil Steril. 2018;109(3):371–9.

    Article  Google Scholar 

  3. Weiss G, et al. Adenomyosis a variant, not a disease? Evidence from hysterectomized menopausal women in the Study of Women’s Health Across the Nation (SWAN). Fertil Steril. 2009;91(1):201–6.

    Article  Google Scholar 

  4. Vercellini P, et al. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):465–77.

    Article  Google Scholar 

  5. Harada T, et al. The Impact of Adenomyosis on Women’s Fertility. Obstet Gynecol Surv. 2016;71(9):557–68.

    Article  Google Scholar 

  6. Taran FA, et al. Clinical characteristics indicating adenomyosis at the time of hysterectomy: a retrospective study in 291 patients. Arch Gynecol Obstet. 2012;285(6):1571–6.

    Article  Google Scholar 

  7. Reinhold C, et al. Diffuse adenomyosis: comparison of endovaginal US and MR imaging with histopathologic correlation. Radiology. 1996;199(1):151–8.

    Article  CAS  Google Scholar 

  8. Dueholm M, Lundorf E. Transvaginal ultrasound or MRI for diagnosis of adenomyosis. Curr Opin Obstet Gynecol. 2007;19(6):505–12.

    Article  Google Scholar 

  9. Yeniel O, et al. Adenomyosis: prevalence, risk factors, symptoms and clinical findings. Clin Exp Obstet Gynecol. 2007;34(3):163–7.

    CAS  PubMed  Google Scholar 

  10. Maheshwari A, et al. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18(4):374–92.

    Article  Google Scholar 

  11. Abu Hashim H, et al. The prevalence of adenomyosis in an infertile population: a cross-sectional study. Reprod Biomed Online. 2020;40(6):842–50.

    Article  Google Scholar 

  12. Puente JM, et al. Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease. Reprod Biol Endocrinol. 2016;14(1):60.

    Article  CAS  Google Scholar 

  13. Vercellini P, et al. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964–77.

    Article  Google Scholar 

  14. Younes G, Tulandi T. Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. Fertil Steril. 2017;108(3):483-490.e3.

    Article  Google Scholar 

  15. Mavrelos D, et al. The impact of adenomyosis on the outcome of IVF–embryo transfer. Reprod Biomed Online. 2017;35(5):549–54.

    Article  Google Scholar 

  16. Nirgianakis K, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185–206.

    Article  Google Scholar 

  17. Horton J, et al. Reproductive, obstetric, and perinatal outcomes of women with adenomyosis and endometriosis: a systematic review and meta-analysis. Hum Reprod Update. 2019;25(5):592–632.

    Article  Google Scholar 

  18. Huang Y, et al. Miscarriage on Endometriosis and Adenomyosis in Women by Assisted Reproductive Technology or with Spontaneous Conception: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020;2020:4381346.

    PubMed  PubMed Central  Google Scholar 

  19. Bruun MR, et al. Endometriosis and adenomyosis are associated with increased risk of preterm delivery and a small-for-gestational-age child: a systematic review and meta-analysis. Acta Obstet Gynecol Scand. 2018;97(9):1073–90.

    Article  Google Scholar 

  20. Razavi M, et al. Systematic review and meta-analysis of adverse pregnancy outcomes after uterine adenomyosis. Int J Gynaecol Obstet. 2019;145(2):149–57.

    Article  Google Scholar 

  21. Vannuccini S, et al. Role of medical therapy in the management of uterine adenomyosis. Fertil Steril. 2018;109(3):398–405.

    Article  Google Scholar 

  22. Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril. 2014;101(2):472–87.

    Article  Google Scholar 

  23. Younes G, Tulandi T. Conservative Surgery for Adenomyosis and Results: A Systematic Review. J Minim Invasive Gynecol. 2018;25(2):265–76.

    Article  Google Scholar 

  24. Rocha TP, et al. Fertility-Sparing Treatment of Adenomyosis in Patients With Infertility: A Systematic Review of Current Options. Reprod Sci. 2018;25(4):480–6.

    Article  Google Scholar 

  25. Tan J, et al. Reproductive Outcomes after Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis: A Systematic Review. J Minim Invasive Gynecol. 2018;25(4):608–21.

    Article  Google Scholar 

  26. Xie M, et al. Elasticity of adenomyosis is increased after GnRHa therapy and is associated with spontaneous pregnancy in infertile patents. J Gynecol Obstet Hum Reprod. 2019;48(10):849–53.

    Article  Google Scholar 

  27. Goldberger MA, Marshak RH, Hermel M. Roentgen diagnosis of adenomyosis uteri. Am J Obstet Gynecol. 1949;57(3):563–8.

    Article  CAS  Google Scholar 

  28. Stamatopoulos CP, et al. Value of magnetic resonance imaging in diagnosis of adenomyosis and myomas of the uterus. J Minim Invasive Gynecol. 2012;19(5):620–6.

    Article  Google Scholar 

  29. Novellas S, et al. MRI Characteristics of the Uterine Junctional Zone: From Normal to the Diagnosis of Adenomyosis. Am J Roentgenol. 2011;196(5):1206–13.

    Article  Google Scholar 

  30. Kepkep K, et al. Transvaginal sonography in the diagnosis of adenomyosis: which findings are most accurate? Ultrasound Obstet Gynecol. 2007;30(3):341–5.

    Article  CAS  Google Scholar 

  31. Dueholm M. Transvaginal ultrasound for diagnosis of adenomyosis: a review. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):569–82.

    Article  Google Scholar 

  32. Struble J, Reid S, Bedaiwy MA. Adenomyosis: A Clinical Review of a Challenging Gynecologic Condition. J Minim Invasive Gynecol. 2016;23(2):164–85.

    Article  Google Scholar 

  33. Cakmak H, Taylor HS. Implantation failure: molecular mechanisms and clinical treatment. Hum Reprod Update. 2011;17(2):242–53.

    Article  CAS  Google Scholar 

  34. Harada T, et al. The Impact of Adenomyosis on Women’s Fertility. Obstet Gynecol Surv. 2016;71(9):557–68.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC, USA

    Gaby Moawad, Sara Rahman & Fady I. Sharara

  2. Department of Pathology, Wayne State University, Detroit, MI, USA

    Mira H. Kheil

  3. Department of Obstetrics and Gynecology, Faculty of Medicine, Paris Quest (UVSQ), Foch Hospital, Suresnes, France

    Jean Marc Ayoubi

  4. Department of Obstetrics and Gynecology, Maine Line Health, Wynnewood, PN, 19096, USA

    Jordan S. Klebanoff

  5. Virginia Center for Reproductive Medicine, Reston, VA, USA

    Fady I. Sharara

Authors
  1. Gaby Moawad
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  2. Mira H. Kheil
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  3. Jean Marc Ayoubi
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  4. Jordan S. Klebanoff
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  5. Sara Rahman
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  6. Fady I. Sharara
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Contributions

All authors contributed equally to this review paper.

Corresponding author

Correspondence to Gaby Moawad.

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The authors have no relevant financial or non-financial interests to disclose.

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Moawad, G., Kheil, M.H., Ayoubi, J.M. et al. Adenomyosis and infertility. J Assist Reprod Genet 39, 1027–1031 (2022). https://doi.org/10.1007/s10815-022-02476-2

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  • DOI: https://doi.org/10.1007/s10815-022-02476-2

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