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Does presence of adenomyosis affect reproductive outcome in IVF cycles? A retrospective analysis of 973 patients

Published:October 26, 2018DOI:https://doi.org/10.1016/j.rbmo.2018.09.014

      Abstract

      Research question

      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?

      Design

      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.

      Results

      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).

      Conclusion

      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.

      Keywords

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      Biography

      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.
      Key message
      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.