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.
Article info
Publication history
Published online: October 26, 2018
Accepted:
September 20,
2018
Received in revised form:
September 18,
2018
Received:
February 28,
2018
Declaration: The authors report no financial or commercial conflicts of interest.Identification
Copyright
© 2018 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
