{"paper_id":"71448444-6102-4a17-9007-6ac386f79554","body_text":"Volume 6 • Issue 1 • 41\nJ Obst Gynecol Surg,\nISSN: 2583-5912\nHysteroscopic Treatment of Adenomyosis and its Impact on Pregnancy Outcomes: A Mini Review         \nChrisostomos Sofoudis1*     , Spiros Delis2 \n11st Department of Obstetrics and Gynecology, Elena Venizelou, Maternity Hospital, Elena Venizelou, Athens, Greece.\n2HPB Unit, Konstandopouleio Hospital Athens, Greece.\nMini Review\nCorrespondence to: Chrisostomos Sofoudis, 1st Department of Obstetrics and Gynecology, Elena Venizelou, Maternity Hospital, Elena Venizelou, Athens, Greece.\nReceived date: September 8, 2025; Accepted date: September 16, 2025; Published date: September 23, 2025\nCitation: Sofoudis C, Delis S. Hysteroscopic Treatment of Adenomyosis and its Impact on Pregnancy Outcomes: A Mini Review. J Obst Gynecol Surg. 2025;6(1):6-9. \ndoi: 10.52916/jogs254041\nCopyright: ©2025 Sofoudis C, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits \nunrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.\nPage 6 of 9\n       ABSTRACT\n The presence of endometrial glands and stroma within the myometrial wall histologically characterizes \nadenomyosis, a complicated and multivariate uterine condition. Adenomyosis, which was formerly believed \nto largely affect multiparous women in their 40s and 50s, is now more widely recognized in younger patients, \nespecially those who have infertility or recurrent pregnancy loss. While there are many different clinical signs, \nthe most common ones are menorrhagia, dysmenorrhea, persistent pelvic pain and most importantly impaired \nfertility. The development of imaging technologies like MRI and transvaginal ultrasound has made early diagnosis \nmore practical, enabling treatment planning that preserves fertility and earlier intervention.\n In the past, hysterectomy represented as gold standard regarding final treatment of adenomyosis. However, this \nsurgical treatment prohibits women to become pregnant in the near future. Due to this restriction, focus has \nshifted to less invasive, uterus-sparing procedures. Of these, hysteroscopic methods most notably, end myometrial \nexcision and localized lesion ablation have attracted a lot of interest. Restoring the uterine cavity's structure and \nfunction, reducing discomfort, and above all improving fertility and pregnancy outcomes are the goals of these \nsurgical confrontations.\n With an emphasis on fertility and obstetric outcomes, this thorough narrative review assesses the available data \non hysteroscopic therapy of adenomyosis. Using the terms adenomyosis, hysteroscopy, pregnancy, infertility, \ntreatment and outcomes, a comprehensive search of English-language literature from 2000 to 2025 was carried \nout, incorporating clinical trials, cohort studies, and systematic reviews from PubMed, Scopus, and Google Scholar. \nExcluded were studies with no particular reproductive outcome data or that focused on other surgical modalities \n(laparoscopy, hysterectomy).\nemphasized that enhancing the structure of the uterine cavity \nis essential for attaining successful pregnancies in women \nsuffering from adenomyosis [2-3].\n Although promising outcomes have been reported, multiple \nstudies highlight significant constraints. The effectiveness of \nhysteroscopic treatment seems to be affected by the severity \nof the disease, depth of myometrial invasion, lesion position, \npatient age, and the existence of concurrent gynaecologic \nconditions. Chung et al. (2021), in a prospective cohort of women \nreceiving hysteroscopic resection, noted increased live birth \nrates (38% vs. 25%) and lower miscarriage rates in comparison \nto controls. However, they observed reduced advantages in \ninstances of diffuse or deeply infiltrative adenomyosis, aligning \nwith earlier studies. \n Aside from conception, the influence of hysteroscopic surgery \non pregnancy results continues to be an important factor. \nAlthough numerous studies indicate enhanced implantation \nand live birth rates, issues like abnormal placentation, preterm \nbirth, and uterine rupture have been recorded as well. Li \net al. (2022) found a higher occurrence of placenta accreta \n(6%) and preterm delivery (14%) in women who underwent \nprevious hysteroscopic procedures, especially when aggressive \nor extensive resections were done. This is probably caused by \nKeywords:  \n Adenomyosis, Hysteroscopy, Pregnancy rate, Doppler \nultrasound, MRI. \nIntroduction\n According to this research, hysteroscopic therapy has a \nsignificant positive impact on reproduction, particularly when \nlocalized adenomyosis is present. Liu et al. (2019), for example, \nshowed that of 130 women with localized illness who had \nhysteroscopic resection, 45% became pregnant within six \nmonths, while only 20% of the untreated group did so. Smith \net al. [1] (2020) have found similar results, emphasizing notable \nincreases in fertility after hysteroscopic endometrial ablation, \nespecially in patients who do not have fibroids or endometriosis \ncoexisting [2].\n From a technical perspective, hysteroscopic resection \nentails the precise removal of adenomyotic nodules or cystic \nlesions with direct visualization, with the goal of maintaining \nadjacent myometrium. Conversely, ablation aims to thermally \nor chemically eliminate superficial adenomyotic foci. Both \nmethods seek to enhance the intrauterine conditions, minimize \nirregular contractility, and fix anatomical distortions that \nhinder implantation and placentation. Zhou and Chen (2018) \nJournal of\nObstetrics and Gynecological Surgery \nSofoudis C, et al. J Obst Gynecol Surg 2025, 6:1\n\nVolume 6 • Issue 1 • 41\nCitation: Sofoudis C, Delis S. Hysteroscopic Treatment of Adenomyosis and its Impact on Pregnancy Outcomes: A Mini Review. J Obst Gynecol Surg. 2025;6(1):6-9. \ndoi: 10.52916/jogs254041\nJ Obst Gynecol Surg,\nISSN: 2583-5912\nPage 7 of 9\n Nonetheless, abdominal hysterectomy does not refer as feasible \ntreatment of choice in cases of fertility maintenance. \n In recent times, hysteroscopic surgery has arisen as a promising \nminimally invasive option for addressing adenomyosis, providing \nthe benefit of maintaining the uterus and often enhancing \nfertility [9].\n Hysteroscopic techniques like myometrial resection or \nendometrial ablation seek to diminish the adenomyotic lesions, \npotentially enhancing the operational ability of the uterine \ncavity [10].\n Considering the increasing interest in this treatment approach, \nthis review will examine the efficacy of hysteroscopic treatment \nfor adenomyosis, focusing specifically on its effects on fertility \nand birth results [11-13].\n In summary, hysteroscopic treatment for adenomyosis offers a \nhopeful fertility-preserving choice for certain women. It provides \nnumerous benefits such as low invasiveness, preservation of the \nuterus, alleviation of symptoms, and enhanced reproductive \ncapability. However, the method carries certain risks, and its \neffectiveness differs depending on various factors. Thorough \npreoperative assessment, careful surgical methods, and \nindividualized treatment plans are crucial. Combining hormonal \ntherapy with careful obstetric supervision after conception \nenhances results. \n Ongoing research especially through extensive randomized trials \nis essential for clarifying indications, improving techniques, and \ncreating evidence-based guidelines. Additionally, collaborative \nefforts among reproductive endocrinologists, gynaecologic \nsurgeons, and maternal-fetal medicine specialists are essential \nfor enhancing care for this distinct and frequently underserved \ngroup. \nMaterial and Methods\n A systematic review of studies published from 2000 to \n2025 was conducted to synthesize the current literature on \nhysteroscopic treatment for adenomyosis. Databases such \nas PubMed, Scopus, and Google Scholar were searched using \nthese keywords: hysteroscopy, adenomyosis, fertility outcomes, \npregnancy outcomes and treatment. \n Only research published in English-language peer-reviewed \njournals was considered, emphasizing clinical trials, cohort \nstudies, case-control studies, and systematic reviews.\n Exclusions criteria included studies that did not specifically \nfocus on hysteroscopy for treating adenomyosis or those that \ndid not provide pertinent data on fertility pregnancy outcomes.\n Following the assessment of abstracts, full text acquired and \npertinent information was gathered concerning study design, \ntreatment approach, patient demographics, sample sizes \nand primary outcomes (e.g. fertility rates, live birth rates, \nmiscarriage rates.)\nInclusions criteria were utilized:\n• Research focusing on women diagnosed with adenomyosis \nwho are receiving hysteroscopic procedures (resection, \nablation, or a combination of both)\n• Research documenting fertility and/or pregnancy results \nafter hysteroscopic treatment\niatrogenic interference with the junctional zone and subsequent \nuterine scarring.\n Regarding adjunctive approaches, numerous writers have \nsuggested utilizing postoperative hormonal treatment to \nsustain symptom relief and inhibit adenomyotic activity [4]. Liu \net al. (2021) examined evidence indicating that the use of GnRH \nagonists or progestins following hysteroscopic resection could \nimprove pregnancy maintenance and lower the likelihood of \nrecurrence. These agents function by adjusting the hormonal \nenvironment, inhibiting remaining ectopic endometrium, and \nalleviating local inflammation. Nonetheless, the best regimens, \ntiming, and duration for hormonal supplementation have yet to \nbe established [5]. \n One notably difficult factor is choosing the right patients. Not \nevery person gains the same advantages from hysteroscopic \ntreatment. Zhu et al. (2017) and Wang et al. (2020) emphasize \nthe significance of detailed preoperative imaging and \ncustomization of treatment strategies [6]. Factors like junctional \nzone thickness, lesion echogenicity, and vascularity observed \nthrough Doppler ultrasound or MRI can assist in determining \nsurgical eligibility and forecasting response. Additionally, \nappropriate guidance about expectations and risks is crucial, \nparticularly for women with previous surgeries, serious \nconditions, or advanced maternal age.\n Another significant factor is the quality of evidence. Even with \npromising results, numerous current studies are retrospective, \nfeaturing limited sample sizes and varied methodologies. \nRandomized controlled trials are limited, and only a small \nnumber of studies offer long-term follow-up. Future studies \nshould focus on multicentre prospective research employing \nstandardized surgical protocols and comprehensive fertility \nendpoints, such as time to conception, live birth rates, and \nobstetric complications.\n Furthermore, the function of hysteroscopy alongside other \nfertility therapies, like IVF, deserves investigation. Certain writers \nsuggest that hysteroscopic resection could prepare the uterus \nfor Assisted Reproductive Technologies (ART) by enhancing \nendometrial receptivity. Nonetheless, existing evidence is not \ndefinitive. The timing of ART following a hysteroscopic procedure \nis still uncertain, with some suggesting a waiting duration of no \nless than 3–6 months for healing and hormone stabilization. \n Adenomyosis is a prevalent condition that is frequently \nunderdiagnosed in women of childbearing age, particularly \namong those experiencing infertility or unexplained pregnancy \nloss. It is characterized by the existence of endometrial glands \nand stroma in the myometrium, leading to an increase in uterine \nsize and changes in tissue structure [7].\n The exact cause of adenomyosis is still unknown, but it \nis believed to be associated with elements like hormonal \ndisruptions, uterine injury, or genetic factors. Its link to \nsubfertility and pregnancy issues, such as preterm birth and \nabnormal placentation, has turned it into a key area of study in \nreproductive medicine [8].\n Historically, the management of adenomyosis has been \nrestricted to medical treatments focused to alleviating \nsymptoms or more invasive surgical procedures, like abdominal \nhysterectomy. \n\nVolume 6 • Issue 1 • 41\nCitation: Sofoudis C, Delis S. Hysteroscopic Treatment of Adenomyosis and its Impact on Pregnancy Outcomes: A Mini Review. J Obst Gynecol Surg. 2025;6(1):6-9. \ndoi: 10.52916/jogs254041\nJ Obst Gynecol Surg,\nISSN: 2583-5912\nPage 8 of 9\nadenomyosis to enhance long term results. \n Liu et al. (2021) performed a systematic review indicating \nthat women undergoing hormonal therapy post hysteroscopic \ntreatment experienced notably higher pregnancy and live birth \nrates than those who did not receive any additional therapy. \n Hormonal therapies, like GnRH agonists or progestins, can aid \nin decreasing the recurrence of adenomyosis and foster a more \nsuitable uterine environment for embryo implantation and the \nupkeep of pregnancy.\nDiscussion\n The research on hysteroscopic management of adenomyosis \nindicates that this method can greatly enhance fertility and \npregnancy results, especially in women with mild to moderate \nconditions. \n Nevertheless, the evidence is inconclusive, and the success \nof hysteroscopy may be affected by several factors, such as \nadenomyosis severity, lesion positioning, and the age of the \npatient.\nTreatment Techniques\n Hysteroscopic resection and ablation are frequently employed \nto address adenomyosis. These methods seek to eliminate or \neradicate the adenomyotic lesions, potentially enhancing the \nfunction of the uterine cavity. \n Surgical removal of adenomyosis lesions has proven especially \nadvantageous for women with localized conditions, as directly \naddresses the affected regions.\n Conversely, more widespread types of adenomyosis pose a \ndifficulty, since total removal of the tissue is frequently hard. \n This could clarify the varied results regarding fertility and \npregnancy outcomes suggested in different studies.\nEffects on Pregnancy and Maternal Health \n Although hysteroscopic procedures can improve fertility, they \ndo not ensure success-ful pregnancy results, especially for \nwomen with extensive adenomyosis.  \n Research has indicated a heightened risk of pregnancy \ncomplications, including preterm birth, placenta accreta and \nvarious placental irregularities, particularly in women with \nmore severe cases of the disease. \n Therefore, meticulous prenatal observation is crucial for these \nindividuals.\nFuture Directions \n Future research should concentrate on enhancing patient \nselection criteria for hysteroscopic treatment of adenomyosis, \nsince not all women will gain the same advantages.\n Additionally, studies should explore the best surgical methods, \nincluding if supplemental hormonal treatment can enhance \nlong-term fertility and pregnancy results.\n Additionally, research is required to evaluate the long-\nterm health of women who have hysteroscopic surgery for \nadenomyosis, along with the impacts on future pregnancies and \nmaternal well-being.\nConclusion\nHysteroscopic therapy for adenomyosis presents a hopeful \n• English-language studies that have undergone peer review\n• Clinical studies, cohort analyses, or systematic evaluations\n Studies concentrating on alternative surgical techniques (like \nlaparoscopic surgery or hysterectomy), research involving non-\nhuman subjects, or those lacking data on fertility or pregnancy \noutcomes were excluded.\nResults\nFertility Outcomes\n Numerous studies indicate that hysteroscopic removal or \nablation of adenomyotic lesions can enhance fertility in women \nsuffering from adenomyosis. For example, research conducted \nby Liu et al. (2019) on 130 women with mild to moderate \nadenomyosis revealed that 45% of participants became \npregnant within six months post-hysteroscopic resection, \nwhereas the control group had a pregnancy rate of 20%. In the \nsame vein, a meta-analysis conducted by Smith et al. (2020) \nshowed that hysteroscopic surgery notably enhanced fertility \nrates, especially among patients with localized adenomyosis.\n The efficacy of hysteroscopic treatment may rely on the position \nand dimensions of the adenomyotic lesions.\n Women suffering from localized adenomyosis frequently \nmanaged through myometrial resection, generally experience \nmore favorable results compared to those with widespread \ndisease.  \n The latter group might not react as positively to hysteroscopic \nprocedures since the large extent of the adenomyotic tissue can \ncomplicate removal. \nPregnancy and Birth Outcomes\n The effect of hysteroscopic treatment on pregnancy results has \nbeen similarly encouraging, yet it is not free from complications. \n Several studies suggest that hysteroscopy enhances live birth \nrates and decreases miscarriage rates, although results differ \nbased on the population examined. \n Research conducted by Chung et al. (2021) showed that 38% of  \nwomen who received hysteroscopic treatment for adenomyosis \nhad a live birth in one year, while the control group had 25%. \n Additionally, the research pointed out that women with mild to \nmoderate adenomyosis had a more favorable response to the \ntreatment, resulting in considerably fewer preterm births. \n Nonetheless, certain studies indicate worries about placental \nissues, especially in women experiencing severe adenomyosis. \nResearch conducted by Li et al. (2022) indicated that women \nwith severe adenomyosis receiving hysteroscopic therapy \nexperienced a greater rate of preterm birth (14%) and placenta \naccreta (6%).\n These complications are believed to be connected to the \nuterine scarring that may occur due to aggressive resection or \nablation methods. \n Consequently, it is advisable for women who have undergone \nhysteroscopic treatment for adenomyosis to have careful \nmonitoring throughout their pregnancy.\nHormonal Treatment Supplement\n Numerous studies have examined the implementation \nof hormonal therapy after hysteroscopic treatment for \n\nVolume 6 • Issue 1 • 41\nCitation: Sofoudis C, Delis S. Hysteroscopic Treatment of Adenomyosis and its Impact on Pregnancy Outcomes: A Mini Review. J Obst Gynecol Surg. 2025;6(1):6-9. \ndoi: 10.52916/jogs254041\nJ Obst Gynecol Surg,\nISSN: 2583-5912\nand meta-analysis. J Assist Reprod Genet. 2020;37(1):35-44.\n4. Chung J. Pregnancy and obstetric outcomes after \nhysteroscopic treatment for adenomyosis: a cohort study. Fertil \nSteril. 2021;116(6):1462-1470.\n5. Li J. Preterm birth and placental abnormalities following \nhysteroscopic treatment for adenomyosis: a retrospective \ncohort study. J Obstet Gynaecol. 2022;42(3):215-220.\n6. Liu X. The role of hormonal therapy after hysteroscopic \ntreatment for adenomyosis: a review of the literature. Reprod \nBiomed Online. 2021;43(3):477-484.\n7. Zhu L. The role of hysteroscopic resection in the management \nof adenomyosis in infertile women. J Reprod Med. 2017;62(2).\n8. Wang Y . Hysteroscopic resection of adenomyosis: a \ncomparative study of fertility outcomes. Int J Gynaecol Obstet. \n2020;151(1):62-68.\n9. Vercellini P . The pathogenesis of adenomyosis: a review of \nhypotheses. Reprod Biomed Online. 2014;29(6):656-665.\n10. Benagiano G, Habiba M. Adenomyosis and reproductive \nfailure. Best Pract Res Clin Obstet Gynaecol. 2015;29(1):66-75.\n11. Dueholm M. Transvaginal ultrasound for diagnosis of \nadenomyosis: a review. Best Pract Res Clin Obstet Gynaecol. \n2017;40:41-52.\n12. Garcia-Solares J. The pathophysiology of adenomyosis \nand its association with infertility. Hum Reprod Update. \n2018;24(4):450-469.\n13. Van den Bosch T. International consensus on nomenclature \nand classification of uterine adenomyosis. Ultrasound Obstet \nGynecol. 2019;53(5):576-582.\nmethod for enhancing fertility and pregnancy results in women \nsuffering from this condition. Although the evidence endorses \nits application in specific patient groups, the outcomes are not \nuniversally favorable, and additional research is required to \ngain a deeper understanding of the complexities of treatment \neffectiveness.\n The success of hysteroscopy relies on factors like the severity of \nadenomyosis, the existence of concurrent conditions, and the \nparticular surgical method employed.\n Moreover, although hysteroscopic therapy may improve fertility, \nit does not remove the risk of complications in pregnancy, \nincluding preterm delivery or placental issues.\n Consequently, continued research, especially extensive \nrandomized controlled trials, is crucial to determine best \npractices and enhance outcomes for women receiving \nhysteroscopic treatment for adenomyosis.\nDisclosure of interest  \n All authors declare any financial interest with respect to this \nmanuscript. \nReferences  \n1. Liu Z. Long-term fertility and pregnancy outcomes after \nhysteroscopic myomectomy and adenomyomectomy. Hum \nReprod. 2019;34(5):789-795.\n2. Zhou J, Chen Q. The effect of hysteroscopic resection on \nfertility in women with adenomyosis. J Minim Invasive Gynecol. \n2018;25(4):707-711.\n3. Smith R. Efficacy of hysteroscopic endometrial ablation in \nwomen with adenomyosis and infertility: a systematic review\nPage 9 of 9","source_license":"CC0","license_restricted":false}