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The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis

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Abstract

To investigate the impact of uterine adenomyosis on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) clinical outcomes and also to evaluate the impact of gonadotropin-releasing hormone agonist (GnRHa) and surgical treatments. Infertile women with adenomyosis undergoing conventional IVF or ICSI were compared with women without adenomyosis. Fertility outcomes were evaluated in two patients with adenomyosis untreated and treated surgically or medically therapy. The review protocol was registered in PROSPERO (CRD42020214586). We consider the live birth rate (LBR) as the primary outcome. The analysis showed that women with adenomyosis had lower LBR (OR 0.59, 95% CI 0.37–0.92, p = 0.02), clinical pregnancy rate (OR 0.66, 95% CI 0.48–0.90), and ongoing pregnancy rate (OR 0.43, 95% CI 0.21–0.88) compared to those without adenomyosis, and miscarriage rate was higher in women with adenomyosis (OR 2.11, 95% CI 1.33–3.33). Surgical treatment increases natural conception in women with adenomyosis although the paucity of data (only two studies), and conversely, treatment with GnRHa does not increase the IVF outcomes. Women with adenomyosis have decreased IVF clinical outcomes. Pretreatment with the use of long-term GnRHa could not be beneficial, even though only three studies were included in the meta-analysis. The major part of the studies has not divided focal and diffuse adenomyosis, and this represents a relevant source of bias: studies conducted with standardized diagnostic criteria for adenomyosis are still needed to determine if the different clinical presentations of such condition could compromise IVF outcomes.

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Code Availability

PROSPERO registration CRD42020214586.

Abbreviations

GnRHa:

Gonadotropin-releasing hormone agonist

ART:

Assisted reproductive technology

COCs:

Number of total oocytes

CPR:

Clinical pregnancy rate

ITGA1:

Integrin alpha-1

ITGB1:

Integrin beta-1

LAMC1:

Laminin subunit gamma-1

LBR:

Live birth rate

LNG-IUS:

Levonorgestrel-releasing intrauterine system

MR:

Miscarriage rate

MRI:

Magnetic resonance imaging

OPR:

Ongoing pregnancy rate

SGA:

Small-for-gestational-age

TVUS:

Transvaginal ultrasound scan

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Authors and Affiliations

  1. IVIRMA Rome, Largo Ildebrando Pizzetti 1, 00197, Rome, Italy

    Mauro Cozzolino & Livia Pellegrini

  2. Universidad Rey Juan Carlos, Calle Tulipán, 28933, Móstoles, Madrid, Spain

    Mauro Cozzolino

  3. Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06510, USA

    Mauro Cozzolino

  4. Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133, Rome, Italy

    Silvio Tartaglia & Giuseppe Rizzo

  5. U.O.C. Di Ostetricia E Patologia Ostetrica, Dipartimento Di Scienza Della Salute Della Donna E del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy

    Silvio Tartaglia

  6. Asst Melegnano Martesana, Vizzolo Predabissi, Milan, Italy

    Gianmarco Troiano

  7. Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Rome, Italy

    Giuseppe Rizzo

  8. Department of Obstetrics and Gynecology, The First IM Sechenov, Moscow State University, Moscow, Russian Federation

    Giuseppe Rizzo

  9. Department of Experimental and Clinical Biomedical Sciences “M. Serio”, The University of Florence, Florence, Italy

    Felice Petraglia

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  1. Mauro Cozzolino
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Cozzolino, M., Tartaglia, S., Pellegrini, L. et al. The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis. Reprod. Sci. 29, 3177–3193 (2022). https://doi.org/10.1007/s43032-021-00818-6

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