OC16.01: Prospective evaluation of impact of adenomyosis on in vitro fertilisation outcome

To examine the impact of adenomyosis on outcome of in vitro fertilisation cycle and whether specific features of adenomyosis are associated with poor outcome. This is a prospective observational study in a population of women undergoing their first IVF cycle in two London teaching hospitals between April 2013 and October 2015. Women underwent a detailed transvaginal ultrasound scan prior to starting fertility treatment. The diagnosis of adenomyosis was made by visualisation of established ultrasonic criteria: an asymmetric myometrium, a globular shaped uterus, myometrial cysts and endometrial striae. We followed up all women and recorded the outcome of their IVF cycle. Women with other uterine pathology were not recruited. During the study period 425 women were recruited. 66 women were excluded from further analysis for a variety of reasons. 72/359 (20.1%, 95% CI 16.0 – 24.3) women had evidence of adenomyosis on scan. Clinical pregnancy rate was 143/359 (39.8%, 95% CI 34.7 – 44.9), miscarriage rate was 28/143 (19.6%, 95% CI 13.1 – 26.1) and 115/359 (32.0%, 95% CI 27.2 – 36.8) women had livebirth. Clinical pregnancy rate in women with adenomyosis was 20/72 (27.8% 95% CI 17.5 – 38.2) vs. 123/287 (42.9%, 95% CI 37.2 – 48.6) in those without (RR 0.65 95% CI 0.44 – 0.96, p = 0.0317). Logistic regression selected myometrial cysts as significant poor outcome predictor (OR 0.391, 95% CI 0.202 – 0.756). Globular uterus (OR 0.499, 95% CI 0.164 – 1.520), endometrial striae (OR 1. 441, 95% CI 0.484 – 4.289) and asymmetrical thickening of the myometrium (OR 0.770, 95% CI 0.250 – 2.335) were not included in the model. Clinical pregnancy was significantly lower in women with multiple morphological features of adenomyosis (OR 0.745, 95% CI 0.592 – 0.932) with only 1/11 (9.1% 95% CI 0.0 – 26.1) women with all 4 features achieving clinical pregnancy (p = 0.001). Adenomyosis has a significant negative impact on IVF outcome. Probably successful treatment was lower in women with evidence of myometrial cysts and those with multiple features of adenomyosis.