Effects of localisation of uterine adenomyosis on outcome of in vitro fertilisation/intracytoplasmic sperm injection fresh and frozen-thawed embryo transfer cycles: a multicentre retrospective cohort study

Takuya Iwasawa, Toshifumi Takahashi, Eri Maeda, Koichi Ishiyama, Satoshi Takahashi, Ryota Suganuma, Koki Matsuo, Masahito Tachibana, Rie Fukuhara, Hiromitsu Shirasawa, Wataru Sato, Yukiyo Kumazawa, Yukihiro Terada
Reproductive biology and endocrinology : RB&E · 2021 · vol. 19(1) , pp. 84 · doi:10.1186/s12958-021-00764-7 · PMID:34088314 · W3165472885
article OA: gold CC0 ⤵ 12 in-corpus citations
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⚙ AI-generated summary by claude@2026-06, 2026-06-10 ⓘ

This study found that extrinsic adenomyotic lesions were associated with lower pregnancy loss and higher live birth rates compared to advanced lesions in IVF/ICSI embryo transfer cycles.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-10 ⓘ

This multicentre retrospective cohort study evaluated 52 infertile patients with MRI-confirmed uterine adenomyosis (2012–2016) who underwent IVF/ICSI with fresh and frozen-thawed embryo transfers, classifying adenomyotic lesion localisation into advanced, extrinsic, and intrinsic subtypes based on radiologists’ MRI assessments. The advanced, extrinsic, and intrinsic groups contributed 100, 27, and 9 embryo transfer cycles, and the study found different pregnancy loss and live birth rates across localisation groups; after adjustment for age, prior miscarriage, and BMI, logistic regression showed the extrinsic group had fewer pregnancy losses and more live births than the advanced group. The main caveat is that the analysis is retrospective and limited by small numbers in some localisation categories, especially the intrinsic subtype, and the IVF/ICSI protocols were determined by clinicians at each facility. Relevance to endometriosis: although the paper is centrally about uterine adenomyosis, it is included because adenomyosis and endometriosis are both covered as causes of infertility and pelvic pathology affecting ART outcomes in the broader endometriosis/adenomyosis research corpus. This paper is centrally about adenomyosis — localisation of MRI-defined adenomyotic lesions and their association with IVF/ICSI-embryo transfer outcomes.

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Abstract

BACKGROUND: Uterine adenomyosis is a benign disease, common among women in their 40 and 50 s, characterised by ectopic endometrial tissue in the uterine myometrial layer. Adenomyosis causes infertility and has a negative effect on the outcomes of in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) embryo transfer (ET) cycles. It has also been reported to have different characteristics depending on the adenomyotic lesion localisation. The effect of its localisation on IVF/ICSI-ET outcomes is unclear. This study aimed to investigate whether adenomyotic lesion localisation, assessed using magnetic resonance imaging (MRI), was associated with outcomes of IVF/ICSI-ET cycles. METHODS: This multicentre, joint, retrospective cohort study analysed the medical records of 67 infertile patients with adenomyosis who underwent IVF/ICSI with fresh and frozen-thawed ET at five participating facilities from January 2012 to December 2016 and for whom MRI data were available. Fifteen patients were excluded; therefore, the MRI data of 52 patients were evaluated by two radiologists. We assessed the localisation of and classified adenomyotic lesions into advanced (invades the full thickness of the uterine myometrium), extrinsic (localised on the serosal side), and intrinsic (localised on the endometrial side) subtypes. RESULTS: There were 40 advanced, nine extrinsic, and three intrinsic cases, and the outcomes of 100, 27, and nine ET cycles, respectively, were analysed. Pregnancy loss/clinical pregnancy and live birth rates of the advanced, extrinsic, and intrinsic groups were 64 % (16/25) and 9 % (9/100), 33.3 % (3/9) and 22.2 % (6/27), and 50 % (1/2) and 11.1 % (1/9), respectively. A logistic regression analysis adjusted for age, prior miscarriage, and body mass index showed that the extrinsic group had fewer pregnancy losses (odds ratio 0.06; 95 % confidence interval [CI]: 0.00-0.54, p = 0.026) and more live births (odds ratio 6.05; 95 % CI: 1.41-29.65, p = 0.018) than the advanced group. CONCLUSIONS: Adenomyotic lesions exert different effects on IVF/ICSI-ET outcomes. Thus, MRI assessments of adenomyosis in infertile patients are beneficial. Establishment of treatment plans based on adenomyotic lesion localisation should be considered.

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Condition tags

mesh:D004715adenomyosisinfertility

MeSH descriptors

Adenomyosis Embryo Transfer Fertilization in Vitro Infertility, Female Pregnancy Rate Sperm Injections, Intracytoplasmic Adenomyosis Adenomyosis Adult Cohort Studies Embryo Transfer Endometriosis Endometriosis Female Humans Infertility, Female Infertility, Female Magnetic Resonance Imaging Pregnancy Retrospective Studies

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