OP03.05: Reproductive outcome in patients ultrasonographically diagnosed adenomyosis

To evaluate reproductive results of patients presenting adenomyosis under Morphological Uterus Sonographic Assessment (MUSA) criteria who underwent assisted reproductive techniques (ART) using oocyte donation or preimplantation genetic testing for aneuploidies (PGT-A). A total of 122 women diagnosed of adenomyosis using the MUSA criteria underwent an embryo transfer under hormonal replacement therapy either from oocyte donation or using PGT-A. Pregnancy rates (PR) and live birth rates (LBR) were analysed according to each of the MUSA criteria, and according to the number of fulfilled criteria. Obstetric outcomes were also evaluated. The mean age of the patients was 42.93 ± 4.39 years old. 86.1% of embryo transfers were performed in the blastocyst stage. The mean number of embryos transferred was 1.24 ± 0.43. The PR, miscarriage rate and LBR were 45.1%, 14.5% and 36.9%, respectively. Among all accepted MUSA criteria, asymmetrical myometrial walls (62.3%) and fan-shaped shadowing (95.9%) were the most prevalent, and none of them represented a negative impact on reproductive outcomes. Adenomyosis patients presented translesional vascularity in 26.2% of cases, and demonstrated worse PR (28.1 versus 51.1%; P = 0.025) and LBR (25.0 versus 41.1%; P = 0.105) than the rest of patients. The presence of hyperechoic islands (13.9%) also showed a negative impact on PR (29.4 versus 47.6%; P = 0.162) and LBR (17.6 versus 40.0%; P = 0.076), although differences did not reach statistical significance. Mean gestational age at delivery was 37.7 ± 3.28 weeks. A total of 4 pregnancies (14.3%) were preterm. Caesarean section was used in 64.3% of deliveries. Mean birthweight was 2980 ± 607.27g and 14.3% of the newborns presented a birthweight < 2500g. Placenta previa was present in 1.6% of the pregnancies. When using embryos from oocyte donation or PGT-A in patients with adenomyosis, reproductive outcomes are reassuring. Only patients with translesional vascularity and fan-shaped shadowing seem to present worse results.