Reports on the effect of adenomyosis on assisted reproductive technology (ART) outcomes are conflicting. Does presence of adenomyosis affect reproductive outcome in IVF cycles in women pretreated with gonadotrophin releasing hormone (GnRH) agonist?
In this retrospective cohort study, 973 women were divided into four groups: only endometriosis (n = 355); endometriosis and adenomyosis (n = 88); adenomyosis alone (n = 64); and tubal factor infertility as controls (n = 466). The pregnancy outcome parameters (clinical pregnancy, miscarriage rate, live birth rate) were compared between these groups.
The clinical pregnancy rate was 36.62% in women with endometriosis alone, 22.72% in women with endometriosis and adenomyosis, 23.44% in women who only had adenomyosis and 34.55% in controls. Miscarriage rates were as follows: 14.62%, 35%, 40% and 13.04%, respectively. Live birth rates were 27.47% in controls; 26.48% in women with only endometriosis; 11.36% in women with endometriosis and adenomyosis; and 12.5% in women with only adenomyosis. Live birth was observed to be less in adenomyosis groups compared with controls and women with only endometriosis. No significant difference was observed in clinical pregnancy, miscarriage or live birth rate between controls and women with only endometriosis. Live birth rate was significantly different between controls and women with adenomyosis only (P = 0.01) and women with endometriosis and adenomyosis (P = 0.002).
Presence of adenomyosis seems to have adverse effects on IVF outcomes in clinical pregnancy rate, live birth rate and miscarriage rate. Screening for adenomyosis might be considered before ART so that the couple has better awareness of the prognosis.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Reproductive BioMedicine Online
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Revised American Society for Reproductive Medicine classification of endometriosis: 1996.Fertil Steril. 1997. 2012; 67: 817-821
- Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study.Hum Reprod. 2012; 27: 1043-1049
- Nitric oxide inhibits development of embryos and implantation in mice.Mol Hum Reprod. 1998; 4: 503-507
- Role of transvaginal sonography and magnetic resonance imaging in the diagnosis of uterine adenomyosis.Fertil Steril. 2018; 109: 389-397
- Asymptomatic adenomyosis and embryo implantation in IVF cycles.Reprod Biomed Online. 2014; 29: 606-611
Brosens I., Pijnenborg R., Benagiano G. Placenta. 2013. Defective myometrial spiral artery remodelling as a cause of major obstetrical syndromes in endometriosis and adenomyosis. 34(2):100-5.
- Adenomyosis and infertility.Reprod Biomed Online. 2012; 24: 35-46
- Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy.Acta Obstet Gynecol Scand. 2010; 89: 1374-1384
- Effect of a sonographically diffusely enlarged uterus without distinct uterine masses on the outcome of in vitro fertilization-embryo transfer.J Assist Reprod Genet. 1999; 16: 369-372
- The effect of adenomyosis on in vitro fertilisation and intra-cytoplasmic sperm injection treatment outcome.Eur J Obstet Gynecol Reprod Biol. 2011; 158: 229-234
- Uterine adenomyosis in the infertility clinic.Hum Reprod Update. 2003; 9: 139-147
- Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery.Acta Obstet Gynecol Scand. 2017; 96: 715-726
- Uterine adenomyosis: a need for uniform terminology and consensus classification.Reprod Biomed Online. 2008; : 244-248
- The Impact of Adenomyosis on Women’s Fertility.Obstet Gynecol Surv. 2016; 71: 557-568
- Changes in tissue inflammation, angiogenesis and apoptosis in endometriosis, adenomyosis and uterine myoma after GnRH agonist therapy.Hum Reprod. 2010; 25: 642-653
- Structural abnormalities of the uterine wall in women with endometriosis and infertility visualized by vaginal sonography and magnetic resonance imaging.Hum Reprod. 2000; 15: 76-82
- Adenomyosis in endometriosis–prevalence and impact on fertility. Evidence from magnetic resonance imaging.Hum Reprod. 2005; 20: 2309-2316
- The influence of adenomyosis in patients laparoscopically treated for deep endometriosis.J Minim Invasive Gynecol. 2008; 15: 566-570
- Adenomyosis does not affect implantation, but is associated with miscarriage in patients undergoing oocyte donation.Fertil Steril. 2011; 96: 943-950
- Uterine junctional zone at magnetic resonance imaging: a predictor of in vitro fertilization implantation failure.J Obstet Gynaecol Res. 2010; 36: 611-618
- Adenomyosis has no adverse effects on IVF/ICSI outcomes in women with endometriosis treated with long-term pituitary down-regulation before IVF/ICSI.Eur J Obstet Gynecol Reprod Biol. 2010; 151: 62-66
- Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement.J Obstet Gynaecol Res. 2014; 3: 1-5
- Immunohistochemical assessment of superoxide dismutase expression in the endometrium in endometriosis and adenomyosis.Fertil Steril. 1999; 72: 129-134
- Adenomyosis in infertile women: prevalence and the role of 3D ultrasound as a marker of severity of the disease.Reprod Biol Endocrinol. 2016; 14: 60
- Adenomyosis reduces pregnancy rates in infertile women undergoing IVF.Reprod BioMed Online. 2012; 25: 273-277
- Influence of adenomyosis on pregnancy and perinatal outcomes in women with endometriosis.Ultrasound Obstet Gynecol. 2017; ([Epub ahead of print])
- The Risk of Preterm Births Among Pregnant Women With Adenomyosis.J Ultrasound Med. 2018; ([Epub ahead of print])
- The role of GnRH analogues in endometriosis-associated apoptosis and angiogenesis.Gynecol Obstet Invest. 2008; 66: 10-18
- Ultrasound diagnosed adenomyosis has a negative impact on successful implantation following GnRH antagonist IVF treatment.Hum Reprod. 2012; 27: 3487-3492
- Current and Future Medical Treatment of Adenomyosis.Journal of Endometriosis and Pelvic Pain Disorders. 2016; 8: 127-135
- Adenomyosis is a potential cause of recurrent implantation failure during IVF treatment.Aust N Z J Obstet Gynaecol. 2011; 51: 280-283
- An atlas of human gametes and conceptuses: an illustrated reference for assisted reproductive technology.Parthenon Publishing, New York1999
- Adenomyosis: epidemiological factors.Clin Obstet Gynaecol. 2006; 20: 465-477
- Uterine adenomyosis and in vitro fertilization outcome: a systematic review and metaanalysis.Hum Reprod. 2014; 29: 964-977
- In vitro fertilization and embryo transfer outcomes in relation to myometrial thickness.J Assist Reprod Genet. 2011; 28: 1135-1140
Dr Sunita Sharma obtained her medical training (MBBS) in 1994 and MD in Obstetrics and Gynaecology in 1996. She further specialized in Reproductive Medicine at the Institute of Reproductive Medicine, Kolkata, India, under National Board of Examinations in 2009. Presently she is working as an infertility and reproductive medicine consultant in Kolkata, India.
Adenomyosis adversely affects live birth rate in women undergoing IVF cycles compared with women with endometriosis who do not have adenomyosis. Screening for this entity might be considered before IVF. Affected couples should be counselled about reduced success after IVF treatment, and about the associated complications of pregnancy.
Published online: October 26, 2018
Accepted: September 20, 2018
Received in revised form: September 18, 2018
Received: February 28, 2018Declaration: The authors report no financial or commercial conflicts of interest.
© 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.