OC11.04: Direct MUSA features of adenomyosis impact live birth rates after first in vitro fertilization / intracytoplasmic sperm injection treatment

Sara Alson; Ola Björnsson; Stefan R. Hansson; Emir Hénic; P. Sladkevicius

doi:10.1002/uog.27797

OC11.04: Direct MUSA features of adenomyosis impact live birth rates after first in vitro fertilization / intracytoplasmic sperm injection treatment

Sara Alson, Ola Björnsson, Stefan R. Hansson, Emir Hénic, P. Sladkevicius

In: Ultrasound in Obstetrics & Gynecology · 2024 · vol. 64(S1) , pp. 29 · doi:10.1002/uog.27797 · PMID:39250081 · W4402360584

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Women with direct features of adenomyosis identified by MUSA had a lower cumulative live birth rate after their first IVF/ICSI treatment compared to those without.

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This study evaluated the cumulative live birth rates following initial in vitro fertilization or intracytoplasmic sperm injection treatments in 1,037 women aged 25 to 39 years. Researchers utilized systematic two- and three-dimensional transvaginal ultrasound examinations based on the revised Morphological Uterus Sonographic Assessment criteria to identify direct features of adenomyosis prior to treatment initiation. The results demonstrated that women with direct MUSA features experienced significantly lower live birth rates and higher miscarriage frequencies compared to those without these specific sonographic indicators, even after adjusting for age and endometriosis status. This paper is centrally about adenomyosis — specifically examining how direct morphological features identified via ultrasound negatively impact assisted reproductive technology outcomes.

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Abstract

To determine the cumulative live birth rate (CLBR) after the first in vitro fertilization (IVF) or Intracytoplasmic sperm injection (ICSI) treatment in women with or without direct features of adenomyosis, using the revised Morphological Uterus Sonographic Assessment (MUSA) group definitions. We included 1037 women aged 25-≤39 years undergoing their first IVF/ICSI treatment at a university hospital between January 2019 and October 2022. To confirm the presence of direct features of adenomyosis, all women underwent a systematic two – and three-dimensional transvaginal ultrasound examination prior to starting their first fertility treatment. All ultrasound examinations were performed using GE Voluson 10 Expert ultrasound equipment with a 5-9 MHz transvaginal transducer. Modified Poisson regression with robust error variances was used to estimate adjusted relative risk (RR). Adjustments were made for potentially confounding factors such as age and presence of endometriosis. The main outcome measure was CLBR in women with or without adenomyosis. Women with only indirect MUSA features were regarded as not having adenomyosis. The CLBR after the first IVF/ICSI treatment was lower in women with at least one direct feature of adenomyosis, [25/102 (24.5%; 95% CI, 17.5-31.5)] compared to women without any direct feature, [399/935 (42.7%; 95% CI, 39.5-45.8)], p < 0.001. The crude (RR) for live birth for women with direct features of adenomyosis compared to women without was 0.58; 95% CI, 0.41-0.82, p = 0.002 and the adjusted RR for 0.61; 95% CI, 0.47-0.78, p < 0.001. Women with direct features more often had miscarriage after frozen embryo transfer (n = 10/102, 9.8%) compared to women without direct features (n = 29/906, 3.1%), p = 0.003. The presence of direct MUSA features of adenomyosis indicates a reduced chance of live birth after the first IVF/ICSI treatment. For adequate counselling, detailed ultrasound examination should be considered for all women undergoing IVF/ICSI treatment.

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Objectives

Methods

We included 1037 women aged 25-≤39 years undergoing their first IVF/ICSI treatment at a university hospital between January 2019 and October 2022. To confirm the presence of direct features of adenomyosis, all women underwent a systematic two – and three-dimensional transvaginal ultrasound examination prior to starting their first fertility treatment. All ultrasound examinations were performed using GE Voluson 10 Expert ultrasound equipment with a 5-9 MHz transvaginal transducer. Modified Poisson regression with robust error variances was used to estimate adjusted relative risk (RR). Adjustments were made for potentially confounding factors such as age and presence of endometriosis. The main outcome measure was CLBR in women with or without adenomyosis. Women with only indirect MUSA features were regarded as not having adenomyosis.

Results

The CLBR after the first IVF/ICSI treatment was lower in women with at least one direct feature of adenomyosis, [25/102 (24.5%; 95% CI, 17.5-31.5)] compared to women without any direct feature, [399/935 (42.7%; 95% CI, 39.5-45.8)], p < 0.001. The crude (RR) for live birth for women with direct features of adenomyosis compared to women without was 0.58; 95% CI, 0.41-0.82, p = 0.002 and the adjusted RR for 0.61; 95% CI, 0.47-0.78, p < 0.001. Women with direct features more often had miscarriage after frozen embryo transfer (n = 10/102, 9.8%) compared to women without direct features (n = 29/906, 3.1%), p = 0.003.

Conclusions

The presence of direct MUSA features of adenomyosis indicates a reduced chance of live birth after the first IVF/ICSI treatment. For adequate counselling, detailed ultrasound examination should be considered for all women undergoing IVF/ICSI treatment.

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Outcome instruments

MUSA

Condition tags

endometriosisadenomyosis

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