P-751 Fertility and clinical efficacy outcome of a novel method of fertility-preserving adenomyomectomy in infertile women with uterine adenomyosis

Abstract Study question Does surgical removal of adenomyosis have clinical efficacy in infertile women? Summary answer Modified adenomyomectomy as a uterus-sparing surgery could be an effective method for increasing pregnancy rate and conservation of fertility potential in infertile women with adenomyosis. What is known already The relation between uterine adenomyosis and infertility is controversial, but it appears to affect endometrial receptivity and increase the abortion rate. In infertility where uterine conservation is paramount, the treatment of adenomyosis is often complicated, that is to say, medical treatment is often transient and hysterectomy for eradication could not preserve their fertility. At this stage, there is no agreement on the most appropriate therapeutic methods on fertility outcome in infertility patients with adenomyosis. Regarding surgical removal of adenomyosis, including laparoscopic reduction, uterus-sparing surgery appears to be satisfactory and reduced the need for hysterectomy, but needs well designed prospective study. Study design, size, duration A prospective clinical trial was conducted. The subjects consisted of 65 infertile patients with adenomyosis and were enrolled after the failure of In Vitro Fertilization (IVF) for pregnancy from December 2007 to September 2023. Participants/materials, setting, methods All cases were classified as having unexplained infertility, adenomyosis with severe periodic dysmenorrhea and occasional menorrhagia. This newly designed operative procedure included pediatric foley insertion into the uterine cavity, injection of diluted vasopressin along the uterine incision, T- or transverse H-incision on the adenomyotic wall, careful excision of adenomyosis tissue using argon laser under intra-operative ultrasonography. After debulking surgery, patients underwent follow up examination for symptom relief, reduction of adenomyosis by MRI and pregnancy rate. Main results and the role of chance The mean age and the duration of infertility were 35.60 ± 3.37 years and 55.48 ± 48.24 months, respectively. The mean volume of excised specimens of adenomyosis was 94.15 ± 56.63g. The relief of dysmenorrhea was observed clearly in all patients at 6 months after operation (NRS; 7.28 ± 2.29 vs. 1.56 ± 1.29, p < 0.001). The amount of menstrual blood was also significantly decreased (140.44 ± 91.68 vs. 66.33 ± 65.85, p = 0.009). The CA 125 level was significantly decreased at the time of 6 months after operation (187.75 ± 229.52 vs. 20.36 ± 19.19, p = 0.026). Post-operational complications occurred in four patients (subfascial hematoma, ureter fistula, shrinkage of the uterus and premature ovarian insufficiency). Seven patients were lost in the follow-up. Of 38 patients who attempted pregnancy, 18 patients conceived by natural or IVF or thawing ET after the operation (18 of 38; 47.4%). However, miscarriage occurred in five patients, ectopic pregnancy in three patients, preterm delivery in two patients and eight patients (8 of 38; 21.1%) delivered by cesarean section at term. The rest of the patients have been trying to conceive by IVF-ET or natural course. Limitations, reasons for caution The sample size is small, so further study with a larger number of patients will be helpful to investigate the possibility of this result. Wider implications of the findings Present adenomyomectomy was related to symptom relief of dysmenorrhea, menorrhagia and increasing pregnancy rate, implying that it could be considered as a successful method for infertile women with adenomyosis who need fertility preservation. This is one of the few reports on the clinical pregnancy outcome of uterus-sparing surgery in adenomyosis. Trial registration number Yes