Adenomyosis and infertility:what evidence?

Abstract. The tendency of women to delay their first pregnancy until an older age and the widespread use of accurate non-invasive imaging techniques has caused adenomyosis to be diagnosed more often in women with otherwise “unexplained infertility” attending infertility clinics. The prevalence of adenomyosis in the infertility clinic population is however not known. The body of evidence on the association between adenomyosis and infertility is derived from observational studies in women treated by assisted reproductive techniques. The presence of adenomyosis on MRI or TVUS was associated with a 38% decrease (95%CI 5 to 45%) in the likelihood of clinical pregnancy in infertile women treated with IVF/ICSI based on a meta-analysis of 8 studies in 1566 women. Based on a pooling of 7 studies, the presence of adenomyosis was associated with a doubling (95%CI 20% to 275%) of the likelihood of miscarriage in pregnancies of infertile women treated by IVF/ICSI. There was however substantial clinical diversity across the included studies and substantial statistical heterogeneity. The overall study quality is moderate. In conclusion, the body of evidence is at the present not conclusive to establish a causal relationship between adenomyosis and infertility.