Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis

OBJECTIVE: To systematically review and summarize the existing evidence related to the effect of adenomyosis on fertility and on in vitro fertilization (IVF) clinical outcomes, and to explore the effects of surgical or medical treatments. DESIGN: Meta-analysis. SETTING: Not applicable. PATIENT(S): An electronic-based search was performed with the use of the following databases: Pubmed, Embase, Ovid Medline, Cochrane Central Register of Controlled Trials, and Google Scholar, identifying all related articles up to November 2016. We included 11 comparative studies that evaluated the clinical outcomes of IVF treatments in women with (519 patients) and without (1,535 patients) adenomyosis diagnosed with the use of magnetic resonance imaging or transvaginal ultrasound. We also separately evaluated four articles comparing fertility outcomes in two groups of infertile adenomyotic patients untreated and treated surgically or medically with the use of GnRH agonist (GnRHa). INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): Primary outcome: clinical pregnancy rate after IVF. SECONDARY OUTCOMES: rates of implantation, ongoing pregnancy, live birth, miscarriage, and ectopic pregnancy. The summary measures were expressed as odds ratio (OR) and 95% confidence interval (CI). RESULT(S): The rates of implantation, clinical pregnancy per cycle, clinical pregnancy per embryo transfer, ongoing pregnancy, and live birth among women with adenomyosis were significantly lower than in those without adenomyosis. The miscarriage rate in women with adenomyosis was higher than in those without adenomyosis. It appears that surgical treatment or treatment withf GnRHa increases the spontaneous pregnancy rate in women with adenomyosis. CONCLUSION(S): Adenomyosis has a detrimental effect on IVF clinical outcomes. Pretreatment with the use of long-term GnRHa or long protocol could be beneficial.