OP31.04: Evidence of adenomyosis on transvaginal ultrasound and infertility management of patients with endometriosis selected for surgical intervention

To evaluate the prevalence of ultrasound features suggestive of adenomyosis in women with endometriosis undergoing surgery compared to those selected for conservative management. Women who underwent 2D/3D transvaginal ultrasound (TVUS) for diagnosis of endometriosis. Adenomyosis on TVUS was diagnosed in the presence of a minimum of 3 of: asymmetrical myometrial thickening, linear striations, myometrial cysts, hyperechoic islands, irregular endometrial-myometrial junction, parallel shadowing, and localised adenomyomas. Only patients with pathology specimens confirming endometriosis and/or adenomyosis were included. 402 women, mean age 32.7±6.6 years, mean BMI of 23.3±4.9, 35.1% parous. The study (surgery) and control groups (no surgery) included 244 and 158 women, respectively. Women who underwent surgery were more parous, had worse symptoms, but reported less infertility. The presence of any, 3 or more, or 5 or more sonographic features suggestive of adenomyosis was significantly more prevalent in the study group (odds ratio [OR]=1.93-2.7, p<0.004, 95% CI; 1.24-4.09). After controlling for age, for all features but linear striations, the OR for having a specific feature was higher in the study group. Women in the study group who had 5 or more sonographic features of adenomyosis had more than a 2-fold risk of suffering from infertility (OR=2.31, p=0.012, 95% CI; 1.20-4.45). Sonographic features suggestive of adenomyosis are more prevalent in women undergoing surgery for endometriosis compared to women selected for conservative management. Women with more than 5 features have an increased risk of infertility. The presence of adenomyosis on ultrasound should be considered in the management decisions regarding these patients.