Adenomyosis and Subfertility

  • Yasushi HirotaEmail author
  • Yutaka Osuga
Part of the Comprehensive Gynecology and Obstetrics book series (CGO)


Although it had been controversial whether adenomyosis causes infertility, current better imaging techniques have enabled nonsurgical diagnosis of adenomyosis and the studies investigating relationship between adenomyosis and subfertility. Recent studies focusing on the relationship between adenomyosis and subfertility have indicated that adenomyosis is associated with infertility and poor pregnancy outcome. Here we presented the current evidence suggesting the effects of adenomyosis on infertility and other pregnancy outcome.


Adenomyosis Infertility Implantation Miscarriage Cytoreductive surgery 


  1. 1.
    Azziz R. Adenomyosis in pregnancy. A review. J Reprod Med. 1986;31(4):224–7.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Maheshwari A, Gurunath S, Fatima F, Bhattacharya S. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update. 2012;18(4):374–92. Scholar
  3. 3.
    de Souza NM, Brosens JJ, Schwieso JE, Paraschos T, Winston RM. The potential value of magnetic resonance imaging in infertility. Clin Radiol. 1995;50(2):75–9.CrossRefPubMedGoogle Scholar
  4. 4.
    Devlieger R, D'Hooghe T, Timmerman D. Uterine adenomyosis in the infertility clinic. Hum Reprod Update. 2003;9(2):139–47.CrossRefPubMedGoogle Scholar
  5. 5.
    Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis—prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod. 2005;20(8):2309–16. Scholar
  6. 6.
    Leyendecker G, Kunz G, Kissler S, Wildt L. Adenomyosis and reproduction. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):523–46. Scholar
  7. 7.
    Zacharia TT, O’Neill MJ. Prevalence and distribution of adnexal findings suggesting endometriosis in patients with MR diagnosis of adenomyosis. Br J Radiol. 2006;79(940):303–7. Scholar
  8. 8.
    Kissler S, Zangos S, Wiegratz I, Kohl J, Rody A, Gaetje R, et al. Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis. Ann N Y Acad Sci. 2007;1101:38–48. Scholar
  9. 9.
    Tamai K, Koyama T, Umeoka S, Saga T, Fujii S, Togashi K. Spectrum of MR features in adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):583–602. Scholar
  10. 10.
    Hricak H, Alpers C, Crooks LE, Sheldon PE. Magnetic resonance imaging of the female pelvis: initial experience. AJR Am J Roentgenol. 1983;141(6):1119–28. Scholar
  11. 11.
    Reinhold C, Tafazoli F, Wang L. Imaging features of adenomyosis. Hum Reprod Update. 1998;4(4):337–49.CrossRefPubMedGoogle Scholar
  12. 12.
    Gordts S, Brosens JJ, Fusi L, Benagiano G, Brosens I. Uterine adenomyosis: a need for uniform terminology and consensus classification. Reprod Biomed Online. 2008;17(2):244–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The impact of adenomyosis on women’s fertility. Obstet Gynecol Surv. 2016;71(9):557–68. Scholar
  14. 14.
    Piver P. [Uterine factors limiting ART coverage]. J Gynecol Obstet Biol Reprod (Paris). 2005;34(7 Pt 2):5S30–3.Google Scholar
  15. 15.
    Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29(5):964–77. Scholar
  16. 16.
    Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand. 2017;96(6):715–26. Scholar
  17. 17.
    Juang CM, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL. Adenomyosis and risk of preterm delivery. BJOG. 2007;114(2):165–9. Scholar
  18. 18.
    Mochimaru A, Aoki S, Oba MS, Kurasawa K, Takahashi T, Hirahara F. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement. J Obstet Gynaecol Res. 2015;41(4):529–33. Scholar
  19. 19.
    Hashimoto A, Iriyama T, Sayama S, Nakayama T, Komatsu A, Miyauchi A, et al. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J Matern Fetal Neonatal Med. 2018;31:1–6. Scholar
  20. 20.
    Birnholz JC. Ultrasonic visualization of endometrial movements. Fertil Steril. 1984;41(1):157–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kunz G, Beil D, Huppert P, Leyendecker G. Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging. Hum Reprod. 2000;15(1):76–82.CrossRefPubMedGoogle Scholar
  22. 22.
    Orisaka M, Kurokawa T, Shukunami K, Orisaka S, Fukuda MT, Shinagawa A, et al. A comparison of uterine peristalsis in women with normal uteri and uterine leiomyoma by cine magnetic resonance imaging. Eur J Obstet Gynecol Reprod Biol. 2007;135(1):111–5. Scholar
  23. 23.
    Lesny P, Killick SR. The junctional zone of the uterus and its contractions. BJOG. 2004;111(11):1182–9. Scholar
  24. 24.
    Stewart CL, Kaspar P, Brunet LJ, Bhatt H, Gadi I, Kontgen F, et al. Blastocyst implantation depends on maternal expression of leukaemia inhibitory factor. Nature. 1992;359(6390):76–9. Scholar
  25. 25.
    Xiao Y, Sun X, Yang X, Zhang J, Xue Q, Cai B, et al. Leukemia inhibitory factor is dysregulated in the endometrium and uterine flushing fluid of patients with adenomyosis during implantation window. Fertil Steril. 2010;94(1):85–9. Scholar
  26. 26.
    Taylor HS. The role of HOX genes in human implantation. Hum Reprod Update. 2000;6(1):75–9.CrossRefPubMedGoogle Scholar
  27. 27.
    Fischer CP, Kayisili U, Taylor HS. HOXA10 expression is decreased in endometrium of women with adenomyosis. Fertil Steril. 2011;95(3):1133–6. Scholar
  28. 28.
    Garavaglia E, Audrey S, Annalisa I, Stefano F, Iacopo T, Laura C, et al. Adenomyosis and its impact on women fertility. Iran J Reprod Med. 2015;13(6):327–36.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Igarashi M, Abe Y, Fukuda M, Ando A, Miyasaka M, Yoshida M, et al. Novel conservative medical therapy for uterine adenomyosis with a danazol-loaded intrauterine device. Fertil Steril. 2000;74(2):412–3.CrossRefPubMedGoogle Scholar
  30. 30.
    Grow DR, Filer RB. Treatment of adenomyosis with long-term GnRH analogues: a case report. Obstet Gynecol. 1991;78(3 Pt 2):538–9.PubMedGoogle Scholar
  31. 31.
    Nelson JR, Corson SL. Long-term management of adenomyosis with a gonadotropin-releasing hormone agonist: a case report. Fertil Steril. 1993;59(2):441–3.CrossRefPubMedGoogle Scholar
  32. 32.
    Silva PD, Perkins HE, Schauberger CW. Live birth after treatment of severe adenomyosis with a gonadotropin-releasing hormone agonist. Fertil Steril. 1994;61(1):171–2.CrossRefPubMedGoogle Scholar
  33. 33.
    Huang FJ, Kung FT, Chang SY, Hsu TY. Effects of short-course buserelin therapy on adenomyosis. A report of two cases. J Reprod Med. 1999;44(8):741–4.PubMedGoogle Scholar
  34. 34.
    Niu Z, Chen Q, Sun Y, Feng Y. Long-term pituitary downregulation before frozen embryo transfer could improve pregnancy outcomes in women with adenomyosis. Gynecol Endocrinol. 2013;29(12):1026–30. Scholar
  35. 35.
    Park CW, Choi MH, Yang KM, Song IO. Pregnancy rate in women with adenomyosis undergoing fresh or frozen embryo transfer cycles following gonadotropin-releasing hormone agonist treatment. Clin Exp Reprod Med. 2016;43(3):169–73. Scholar
  36. 36.
    Fujishita A, Masuzaki H, Khan KN, Kitajima M, Ishimaru T. Modified reduction surgery for adenomyosis. A preliminary report of the transverse H incision technique. Gynecol Obstet Investig. 2004;57(3):132–8. Scholar
  37. 37.
    Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC Womens Health. 2015;15:24. Scholar
  38. 38.
    Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22(1):94–9. Scholar
  39. 39.
    Takeuchi H, Kitade M, Kikuchi I, Shimanuki H, Kumakiri J, Kitano T, et al. Laparoscopic adenomyomectomy and hysteroplasty: a novel method. J Minim Invasive Gynecol. 2006;13(2):150–4. Scholar
  40. 40.
    Wang PH, Liu WM, Fuh JL, Cheng MH, Chao HT. Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma. Fertil Steril. 2009;92(3):876–85. Scholar
  41. 41.
    Al Jama FE. Management of adenomyosis in subfertile women and pregnancy outcome. Oman Med J. 2011;26(3):178–81. Scholar
  42. 42.
    Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril. 2014;102(3):802–7.e1. Scholar
  43. 43.
    Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC. Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res. 2009;35(3):495–502. Scholar
  44. 44.
    Wang CJ, Yuen LT, Chang SD, Lee CL, Soong YK. Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis. Fertil Steril. 2006;86(2):462.e5–8. Scholar
  45. 45.
    Huang BS, Seow KM, Tsui KH, Huang CY, Lu YF, Wang PH. Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: long-term follow-up in a series of nine patients. Taiwan J Obstet Gynecol. 2012;51(2):212–6. Scholar
  46. 46.
    Saremi A, Bahrami H, Salehian P, Hakak N, Pooladi A. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed Online. 2014;28(6):753–60. Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Graduate School of MedicineThe University of TokyoTokyoJapan

Personalised recommendations