Impact of adenomyosis on fertility and obstetric outcomes among women in tertiary care center

Adenomyosis is a serious reproductive difficulty caused by aberrant endometrial tissue within the myometrium. It can induce infertility and predispose women to hypertensive problems, preeclampsia, and preterm birth. However, the influence of adenomyosis on fertility and obstetric outcomes has not been extensively explored, particularly in resource-limited settings. This study aimed to investigate the effect of adenomyosis on fertility and obstetric outcomes in women who visited a tertiary care hospital in Dhaka, Bangladesh.

A case control study was conducted in Shahabuddin Medical College Hospital and one IVF center from June 2023 to May 2024. The study included 100 women divided into two groups: A case group of 50 with adenomyosis and 50 in the control group without. Two groups were compared in terms of baseline characteristics, fertility outcomes, obstetric complications, and delivery outcomes. SPSS software statistical analysis was performed.

Obstetric complications such as hypertensive disorders (32% versus 6%, p=0.001), preeclampsia (16% versus 2%, p=0.01) and preterm delivery (26% versus 8%, p=0.01) were more frequent in the adenomyosis group. The adenomyosis group also had a higher caesarean delivery rate (62% versus 34%), p0.05).

Early diagnosis and careful management of adenomyosis are important because adenomyosis is associated with increased obstetric complications and higher caesarean delivery. Metrics

Pontis A, D’alterio MN, Pirarba S, De Angelis C, Tinelli R, Angioni S. Adenomyosis: a systematic review of medical treatment. Gynecol Endocrinol. 2016;32(9):696-700. DOI: https://doi.org/10.1080/09513590.2016.1197200 Vigano P, Corti L, Berlanda N. Beyond infertility: obstetrical and postpartum complications associated with endometriosis and adenomyosis. Fertil Steril. 2015;104(4):802-12. DOI: https://doi.org/10.1016/j.fertnstert.2015.08.030 Champaneria R, Abedin P, Daniels J, Balogun M, Khan KS. Ultrasound scan and magnetic resonance imaging for the diagnosis of adenomyosis: systematic review comparing test accuracy. Acta Obstet Gynecol Scand. 2010;89(11):1374-84. DOI: https://doi.org/10.3109/00016349.2010.512061 Mochimaru A, Aoki S, Oba MS, Kurasawa K, Takahashi T, Hirahara F. Adverse pregnancy outcomes associated with adenomyosis with uterine enlargement. J Obstet Gynaecol Res. 2015;41(4):529-33. DOI: https://doi.org/10.1111/jog.12604 Donnez J, Donnez O, Dolmans MM. Introduction: uterine adenomyosis, another enigmatic disease of our time. Fertil Steril. 2018;109(3):369-70. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.035 Nirgianakis K, Kalaitzopoulos DR, Schwartz AS, Spaanderman M, Kramer BW, Mueller MD, et al. Fertility, pregnancy and neonatal outcomes of patients with adenomyosis: a systematic review and meta-analysis. Reprod Biomed Online. 2021;42(1):185-206. DOI: https://doi.org/10.1016/j.rbmo.2020.09.023 Harada T, Khine YM, Kaponis A, Nikellis T, Decavalas G, Taniguchi F. The impact of adenomyosis on women’s fertility. Obstet Gynecol Surv. 2016 Sep ;71(9):557-68. DOI: https://doi.org/10.1097/OGX.0000000000000346 Juang CM, Chou P, Yen MS, Twu NF, Horng HC, Hsu WL. Adenomyosis and risk of preterm delivery. BJOG. 2007;114(2):165-9. DOI: https://doi.org/10.1111/j.1471-0528.2006.01186.x Buggio L, Dridi D, Barbara G. Adenomyosis: impact on fertility and obstetric outcomes. Reprod Sci. 2021;28(11):3081-4. DOI: https://doi.org/10.1007/s43032-021-00679-z Bazot M, Cortez A, Darai E, Rouger J, Chopier J, Antoine JM, et al. Ultrasonography compared with magnetic resonance imaging for the diagnosis of adenomyosis: correlation with histopathology. Hum Reprod. 2001;16(11):2427-33. DOI: https://doi.org/10.1093/humrep/16.11.2427 Andres MP, Borrelli GM, Ribeiro J, Baracat EC, Abrão MS, Kho RM. Transvaginal ultrasound for the diagnosis of adenomyosis: systematic review and meta-analysis. J Minim Invas Gynecol. 2018;25(2):257-64. DOI: https://doi.org/10.1016/j.jmig.2017.08.653 Sharma S, Bathwal S, Agarwal N, Chattopadhyay R, Saha I, Chakravarty B. Does presence of adenomyosis affect reproductive outcome in IVF cycles? A retrospective analysis of 973 patients. Reprod biomed Online. 2019;38(1):13-21. DOI: https://doi.org/10.1016/j.rbmo.2018.09.014 Vercellini P, Bonfanti I, Berlanda N. Adenomyosis and infertility: is there a causal link? Exp Rev Endocrinol Metab. 2019;14(6):365-7. DOI: https://doi.org/10.1080/17446651.2019.1697675 Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril. 2018 Mar 1;109(3):380-8. DOI: https://doi.org/10.1016/j.fertnstert.2018.01.006 Moawad G, Kheil MH, Ayoubi JM, Klebanoff JS, Rahman S, Sharara FI. Adenomyosis and infertility. J Assist Reprod Genet. 2022;39(5):1027-31. DOI: https://doi.org/10.1007/s10815-022-02476-2 French HM, Zhang W, Movilla PR, Isaacson KB, Morris SN. Adenomyosis and fertility: does adenomyosis impact fertility and does treatment improve outcomes. Curr Opin Obstet Gynecol. 2022;34(4):227-36. DOI: https://doi.org/10.1097/GCO.0000000000000789 Hashimoto A, Iriyama T, Sayama S, Nakayama T, Komatsu A, Miyauchi A, et al. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. The Journal of Maternal-Fetal & Neonatal Medicine. 2018 Feb 1;31(3):364-9. DOI: https://doi.org/10.1080/14767058.2017.1285895 Petraglia F, Arcuri F, De Ziegler D, Chapron C. Inflammation: a link between endometriosis and preterm birth. Fertil Steril. 2012;98(1):36-40. DOI: https://doi.org/10.1016/j.fertnstert.2012.04.051 Van den Bosch T, Dueholm M, Leone FP, Valentin L, Rasmussen CK, Votino A, et al. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol. 2015;46(3):284-98. DOI: https://doi.org/10.1002/uog.14806