Adenomyosis and its impact on fertility

In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2019 · vol. 8(10) , pp. 4135 · doi:10.18203/2320-1770.ijrcog20194186 · W2972880626
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AI-generated summary by gemini-2.5-flash-lite, 2026-06-12

This literature review examines how adenomyosis negatively impacts women's reproductive outcomes, pregnancy rates, and pregnancy results after various treatments including medical, surgical, and IVF.

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AI-generated deep summary by claude@2026-06, 2026-06-10 · read from full text

This paper is a literature-focused review examining how estrogen-dependent uterine adenomyosis affects reproductive outcomes, including pregnancy rates and perinatal outcomes, in women of reproductive age with infertility who undergo medical treatment, surgical uterus-sparing approaches, or IVF. It highlights that adenomyosis has a negative impact on reproductive ability and describes the challenges of preserving fertility compared with hysterectomy, which is framed as the gold standard for those without fertility goals. A key caveat is that the paper synthesizes evidence across multiple interventions and study types rather than reporting original experimental results, limiting the ability to directly compare approaches or establish definitive effect sizes. Relevance to endometriosis: the review is centrally about adenomyosis, but it explicitly includes endometriosis in related infertility mechanisms via citations discussing adenomyosis and endometriosis together, such as uterotubal transport disorders contributing to infertility. This paper is centrally about adenomyosis — its focus is how adenomyosis impacts fertility and pregnancy outcomes across treatments including IVF, directly relating to adenomyosis-associated infertility.

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Abstract

Adenomyosis is an estrogen dependent benign gynecological disease affecting women of reproductive age causing them to have an adverse effect. Symptoms in these patients include pelvic pain, menorrhagia, abnormal uterine bleeding and infertility. It has a negative impact on a woman’s reproductive ability. The gold standard treatment for adenomyosis is hysterectomy for whom fertility is not an issue and for whom future pregnancy has no concerns, however females who wish to retain uterus for child bearing purposes the treatment seems to be very challenging. In this literature we will focus on how adenomyosis affects the reproductive outcome in women and what is its impact on the pregnancy rate also we will enlighten the pregnancy outcomes and pregnancy rate in patient with adenomyosis after various treatment Including the medical, surgical and in-vitro fertilization.
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Adenomyosis and its impact on fertility DOI: https://doi.org/10.18203/2320-1770.ijrcog20194186Keywords: Adenomyosis, Infertility, IVF, Pregnancy outcomeAbstract Adenomyosis is an estrogen dependent benign gynecological disease affecting women of reproductive age causing them to have an adverse effect. Symptoms in these patients include pelvic pain, menorrhagia, abnormal uterine bleeding and infertility. It has a negative impact on a woman’s reproductive ability. The gold standard treatment for adenomyosis is hysterectomy for whom fertility is not an issue and for whom future pregnancy has no concerns, however females who wish to retain uterus for child bearing purposes the treatment seems to be very challenging. In this literature we will focus on how adenomyosis affects the reproductive outcome in women and what is its impact on the pregnancy rate also we will enlighten the pregnancy outcomes and pregnancy rate in patient with adenomyosis after various treatment Including the medical, surgical and in-vitro fertilization. Metrics References Hiroshi T, Hiroshi K, Mari K, Mikiko AS, Atsushi T, Takashi M, et al. Complications and outcomes of pregnant women with adenomyosis in Japan. Reprod Med Biol. 2017;16:330-6. Bergeron C, Amant F, Ferenczy A. Pathology and physiopathology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:511‐21. Vercellini P, Vigano P, Somigliana E. Adenomyosis: epidemiological factors. Best Pract Res Clin Obstet Gynaecol. 2006;20:465-77. Peric H, Fraser IS. The symptomatology of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20:547-55. Streuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C. An update on the pharmacological management of adenomyosis. Expert Opin Pharmacother. 2014;15(16):2347-60. Farquhar C, Brosens I. Medical and surgical manage ment of adenomyosis. Best Pract Res Clin Obstet Gynaecol. 2006;20(4):603-16. Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC. Is the surgical approach benefcial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res. 2009;35(3):495-502. Kissler S, Hamscho N, Zangos S, Wiegratz I, Schlichter S, Menzel C, et al. Uterotubal transport disorder in adenomyosis and endometriosis: a cause for infertility. BJOG. 2006;113:902-8. Rasmussen CK, Glavind J, Madsen LD, Uldbjerg N, Dueholm M. Repeatability of junctional zone measurements using 3-dimensional transvaginal sonography in healthy fertile women. J Ultrasound Med. 2016;35:1497-508. Kunz G, Beil D, Huppert P, Noe M, Kissler S, Leyendecker G. Adenomyosis in endometriosis--prevalence and impact on fertility. Evidence from magnetic resonance imaging. Hum Reprod. 2005;20:2309-16 Vercellini P, Consonni D, Barbara G, Buggio L, Frattaruolo MP, Somigliana E. Adenomyosis and reproductive performance after surgery for rectovaginal and colorectal endometriosis: a systematic review and meta-analysis. Reprod Biomed Online. 2014;28:704-13. Salim R, Riris S, Saab W, Abramov B, Khadum I, Serhal P. Adenomyosis reduces pregnancy rates in infertile women undergoing IVF. Reprod Biomed Online. 2012;25:273-7. Osada H, Silber S, Kakinuma T, Nagaishi M, Kato K, Kato O. Surgical procedure to conserve the uterus for future pregnancy in patients suffering from massive adenomyosis. Reprod Biomed Online. 2011;22(1):94-9. Saremi A, Bahrami H, Salehian P, Hakak N, Pooladi A. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique. Reprod Biomed Online. 2014;28(6):753-60. Campo S, Campo V, Benagiano G. Adenomyosis and infertility. Reprod Biomed Online. 2012;24:35-46. Pontis A, D'Alterio MN, Pirarba S, de Angelis C, Tinelli R, Angioni S. Adenomyosis: a systematic review of medical treatment. Gynecol Endocrinol. 2016:1-5. Imaoka I, Ascher SM, Sugimura K, Takahashi K, Li H, Cuomo F, et al. MR imaging of diffuse adenomyosis changes after GnRH analog therapy. J Magnet Reson Imag. 2002;15:285-90. Khan KN, Kitajima M, Hiraki K, Fujishita A, Nakashima M, Masuzaki H. Decreased expression of human heat shock protein 70 in the endometria and pathological lesions of women with adenomyosis and uterine myoma after GnRH agonist therapy. Eur J Obstet Gynecol Reprod Biol. 2015;187:6-13. Niu Z, Chen Q, Sun Y, Feng Y. Long-term pituitary down regulation before frozen embryo transfer could improve pregnancy outcomes in women with adenomyosis. Gynecol Endocrinol. 2013;29:1026-30. Huang X, Huang Q, Chen S, Zhang J, Lin K, Zhang X. Efficacy of laparoscopic adenomyomectomy using double-flap method for diffuse uterine adenomyosis. BMC Women's Health. 2015;15:24. Fujishita A, Masuzaki H, Khan KN, Kitajima M, Ishimaru T. Modified reduction surgery for adenomyosis. A preliminary report of the transverse H incision technique. Gynecol Obstet Invest. 2004;57:132-8. Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus-sparing surgery in adenomyosis-associated subfertility? Fertil Steril. 2014;102:802-7.e1. Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC. Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res. 2009;35:495-502. Otsubo Y, Nishida M, Arai Y, Ichikawa R, Taneichi A, Sakanaka M. Association of uterine wall thickness with pregnancy outcome following uterine-sparing surgery for diffuse uterine adenomyosis. Aust N Z J Obstet Gynaecol. 2016;56:88-91. Tsui KH, Lee FK, Seow KM, Chang WC, Wang JW, Chen SU, et al. Conservative surgical treatment of adenomyosis to improve fertility: controversial values, indications, complications, and pregnancy outcomes. Taiwan J Obstet Gynecol. 2015;54(6):635-40. Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril. 2014;101(2):472-87. Kishi Y, Yabuta M, Taniguchi F. Who will benefit from uterus sparing surgery in adenomyosis-associated subfertility? Fertil Steril. 2014;102(3):802-7. Hirata JD, Moghissi KS, Ginsburg KA. Pregnancy after medical therapy of adenomyosis with a gonadotropin-releasing hormone agonist. Fertil Steril. 1993;59:444-5. Devlieger R, D'Hooghe T, Timmerman D. Uterine adenomyosis in the infer tility clinic. Hum Reprod Update. 2003;9:139-47. Niu Z, Chen Q, Sun Y, Feng Y. Long-term pituitary downregulation before frozen embryo transfer could improve pregnancy outcomes in women with adenomyosis. Gynecol Endocrinol. 2013;29:1026-30. Park CW, Choi MH, Yang KM, Song IO. Pregnancy rate in women with adenomyosis undergoing fresh or frozen embryo transfer cycles following gonadotropin-releasing hormone agonist treatment. Clin Exp Reprod Med. 2016;43:169-73. Streuli I, Dubuisson J, Santulli P, de Ziegler D, Batteux F, Chapron C. An update on the pharmacological management of adenomyosis. Expert Opin Pharmacother. 2014;15:2347-60. Niu Z, Chen Q, Sun Y, Feng Y. Long-term pituitary down regulation before frozen embryo transfer could improve pregnancy outcomes in women with adenomyosis. Gynecol Endocrinol. 2013;29:1026-30. Vercellini P, Consonni D, Dridi D, Bracco B, Frattaruolo MP, Somigliana E. Uterine adenomyosis and in vitro fertilization outcome: a systematic review and meta-analysis. Hum Reprod. 2014;29:964-77. Hashimoto A, Iriyama T, Sayama S. Adenomyosis and adverse perinatal outcomes: increased risk of second trimester miscarriage, preeclampsia, and placental malposition. J Matern Fetal Neonatal Med. 2018;31(3):364-9.

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