Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study

Kota Tanaka, Tanaka K, Ono Y, Yosuke Ono, Ota H, Hajime Ota, Dai Miyashita, Miyashita D, Tatsuya Yoshihara, Yoshihara T, So Owada, Owada S, Sasatsu S, Satoko Sasatsu, Maki Ogi, Ogi M, Okuda Y, Yasuhiko Okuda, Yamada H, Hideto Yamada, Wada S, Shinichiro Wada, Osamu Yoshino, Yoshino O
Archives of gynecology and obstetrics · 2026 · vol. 313(1) · doi:10.1007/s00404-026-08490-4 · PMID:42360496 · PMC13562353 · W7166100353
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This retrospective study of 199 women with adenomyosis found that lesion thickness and coexisting endometriosis predict assisted reproductive technology use and live birth rates differently across intrinsic, extrinsic, and indeterminate subtypes.

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This retrospective multicenter study analyzed 199 premenopausal women with histopathologically confirmed adenomyosis to identify factors influencing assisted reproductive technology use and live birth rates across MRI-defined intrinsic, extrinsic, and indeterminate subtypes. The researchers found that lesion thickness significantly predicted lower odds of live birth in the extrinsic subtype, while older age correlated with ART use and ovarian endometrioma presence reduced live birth likelihood in the indeterminate subtype. A major limitation noted was the retrospective design, which inherently restricts causal inference regarding these associations. This paper is centrally about adenomyosis — specifically examining how subtype classification and coexisting endometriosis impact fertility outcomes.

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Abstract

PURPOSE: The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear. METHODS: We conducted a multicenter retrospective study of 199 premenopausal women (32-49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010-May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings-including pelvic endometriosis-with ART use and live birth. RESULTS: The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88-0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002-1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054-0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor. CONCLUSION: Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management.
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Abstract

Purpose The magnetic resonance imaging (MRI)-based classification of adenomyosis subtypes helps predict reproductive and obstetric outcomes; however, background factors associated with use of assisted reproductive technology (ART) and live birth within each individual subtype remain unclear.

Methods

We conducted a multicenter retrospective study of 199 premenopausal women (32–49 years) who underwent pelvic MRI and laparoscopic surgery and had histopathologic confirmation of adenomyosis (January 2010–May 2023). Patients were classified as intrinsic (n = 58), extrinsic (n = 61), or indeterminate (n = 80) subtype. Within each subtype, multivariate logistic regression tested independent associations of age, ART history, gravidity, parity, lesion thickness, and intraoperative findings—including pelvic endometriosis—with ART use and live birth.

Results

The extrinsic subtype had a higher proportion with ART history than the intrinsic subtype (32.8% vs 8.6%; p = 0.008). Live birth rate was lower in the indeterminate than the intrinsic subtype (60.0% vs 86.2%; p = 0.0048). In the extrinsic subtype, greater lesion thickness independently predicted lower odds of live birth (adjusted OR = 0.94 per 1-mm increase; 95% CI, 0.88–0.99; p = 0.048). In the indeterminate subtype, older age was associated with ART use (adjusted OR = 1.155 per year; 95% CI, 1.002–1.351; p = 0.047), and ovarian endometrioma was linked to reduced live birth (adjusted OR = 0.172; 95% CI, 0.054–0.508; p = 0.001). In the intrinsic subtype, women with live birth were older than those without, but age was not an independent factor.

Conclusion

Adenomyosis lesion thickness and coexisting endometriosis are associated with ART indication and live birth outcomes in a subtype-specific manner and may support individualized counselling and management. Similar content being viewed by others

Acknowledgements

We thank all members of obstetricians and gynecologists in University of Yamanashi Hospital and Teine Keijinkai Hospital for their contributions to this study. Funding Open Access funding provided by University of Yamanashi. None. Author information Authors and Affiliations Corresponding author Ethics declarations Conflict of interest The authors declare that this study was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. This article was approved by the hospital’s ethical committee, and it has duly received IRB approval. Ethical approval Human rights statements and informed consent: This study was conducted in accordance with the principles outlined in the Declaration of Helsinki, and it was approved by the Institutional Review Board of the University of Yamanashi (approval number: CS 0013). Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information Below is the link to the electronic supplementary material. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. About this article Cite this article Tanaka, K., Ono, Y., Ota, H. et al. Subtype-specific analysis of factors associated with assisted reproductive technology indication and live birth in patients with adenomyosis: a retrospective study. Arch Gynecol Obstet (2026). https://doi.org/10.1007/s00404-026-08490-4 Received: Accepted: Published: DOI: https://doi.org/10.1007/s00404-026-08490-4

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MeSH descriptors

Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis Adenomyosis

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Papers in the corpus that this work cites (lower rings, blue) and that cite this one (upper rings, green). Dot size scales with the paper's in-corpus citation count — bigger dot = more influential within the endo/adeno field. Click a dot to open that paper. [ expand to 2 hops ] — adds papers reached through this work's immediate citers/citees. Heavier; up to 60 extra dots.

References (33)

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organisms 3
noordeloos 2009062 noordeloos 2009062 homo heidelbergensis
chemicals 2
progestin progesterone

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